cardiovascular-agents and Hypertension

This review summarizes recent literature, updated safety data, and major clinical considerations for commonly used medications for arrhythmias, heart failure, hypertension, ischemic heart disease, and anticoagulation during pregnancy and lactation.. Recent studies have shown a benefit to more aggressive treatment of mild chronic hypertension to a blood pressure goal of <140/90 with oral labetalol and nifedipine remaining first-line agents. Aspirin is now routinely used for preeclampsia prevention, while experience with other antiplatelet agents, such as purinergic receptor P2Y G protein-coupled 12 (P2Y12) inhibitors, continues to grow. Data on statin therapy are rapidly changing and recent studies suggest this class may not be associated with fetal harm and can be continued in select cases.. As data regarding medication safety continues to evolve, a multidisciplinary team is needed for full consideration of maternal and fetal risks and benefits. Ongoing studies are needed to improve and expand our understanding of medication safety during pregnancy and lactation.

Topics: Antihypertensive Agents; Aspirin; Cardiovascular Agents; Female; Hematologic Agents; Humans; Hypertension; Labetalol; Platelet Aggregation Inhibitors; Pre-Eclampsia; Pregnancy

The COVID-19 pandemic led to an enormous burden on healthcare systems worldwide. Causal therapy is still in its infancy. Contrary to initial views that the use of angiotensin-converting enzyme inhibitors (ACEi)/angiotensin II receptor blockers (ARBs) may increase the risk for a deleterious disease course, it has been shown that these agents may actually be beneficial for patients affected by COVID-19. In this article, we provide an overview of the three most commonly used classes of drugs in cardiovascular disease (ACEi/ARB, statins, beta-blockers) and their potential role in COVID-19 therapy. More results from randomized clinical trials are necessary to identify patients that can benefit most from the use of the respective drugs.. Die COVID-19-Pandemie hat zu einer enormen Belastung der Gesundheitssysteme weltweit geführt. Die kausale Therapie steckt noch in den Kinderschuhen. Entgegen der Auffassung, dass der Einsatz von Angiotensin-Converting-Enzym(ACE)-Hemmern/Angiotensin-II-Rezeptor-Blockern (ARB) das Risiko für einen deletären Verlauf erhöhen könnte, hat sich gezeigt, dass diese Substanzen sogar einen Nutzen in der COVID-19-Therapie haben könnten. Im vorliegenden Artikel geben die Autoren einen Überblick über die 3 am häufigsten verwendeten Medikamentenklassen bei Herz-Kreislauf-Erkrankungen (ACE-Hemmer/ARB, Statine, Betablocker) und diskutieren ihren möglichen Beitrag zur COVID-19-Therapie. Es sind weitere Ergebnisse aus randomisierten klinischen Studien erforderlich, um die Patienten zu identifizieren, die am meisten vom Einsatz der jeweiligen Medikamente profitieren können.

Topics: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Cardiovascular Agents; COVID-19; Humans; Hypertension; Pandemics; Renin-Angiotensin System

Ten years passed since Japan set out the Action Plan of Growth Strategy that declared the initiatives of digitalization for medicine, nursing care, and healthcare to achieve the world's most advanced medical care. The initiatives formed the foundation of the Japanese national strategy and have been continuously refined, resulting in the current environment of digital health and digital medicine. Digital health-related terminologies are organized, such as "digital health," "digital medicine," and "digital therapeutics" (DTx), as well as several common digital technologies, including artificial intelligence, machine learning, and mobile health (mHealth). DTx is included in mHealth and is a novel disease treatment option. Also, this article thoroughly describes DTx in Japan and compares it with those in the US and Germany, the leading countries in digital health-related policies, regulations, and their development status. In Japan, two of three DTx applications that have been approved and reimbursed by the Ministry of Health, Labor, and Welfare are explained in detail in relation to cardiovascular medicine. When added to a standard smoking cessation program, the DTx system for nicotine dependence significantly improved the continuous abstinence rate. Moreover, the DTx for hypertension together with the guideline-based hypertension management was effective in patients aged 65 years or younger who were diagnosed with essential hypertension without antihypertensive agents, and it was also found to be cost-effective. DTx in cardiovascular medicine, with consideration on safety, efficacy, and cost-effectiveness, could be widely used not only through basic experiments and clinical studies but also through social implementation.

Topics: Aged; Artificial Intelligence; Cardiology; Cardiovascular Agents; Delivery of Health Care; Humans; Hypertension; Japan; Middle Aged

Cardiovascular diseases are associated with an increased risk of depression, but it remains unclear whether treatment with cardiovascular agents decreases or increases this risk. The effects of drugs on individual usage are also often unknown. This review aimed to examine the correlation between depression and common cardiovascular drugs, develop more potent interventions for depression in cardiovascular patients, and further research on the bio-behavioural mechanisms linking cardiovascular drugs to depression.. The data in this review were obtained from articles included in PubMed, EMBASE, and Web of Science.. Clinical trials, observational studies, review literature, and guidelines about depression and cardiovascular drugs were selected for the article.. We systematically investigated whether the seven most used cardiovascular drugs were associated with altered risk of incident depression in this literature review. Statins have been proven to have antidepressant effects. Some studies believe angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blocker (ARB) can exert an antidepressant influence by acting on the renin-angiotensin system, but further clinical trials are needed to confirm this. Beta-blockers have previously been associated with depression, but the current study found no significant association between beta blockers and the risk of depression. Aspirin may have antidepressant effects by suppressing the immune response, but its role as an antidepressant remains controversial. calcium channel blockers (CCBs) can regulate nerve signal transduction by adjusting calcium channels, but whether this effect is beneficial or harmful to depression remains unclear. Finally, some cases have reported that nitrates and diuretics are associated with depression, but the current clinical evidence is insufficient.. Statins have been proven to have antidepressant effect, and the antidepressant effects of ACEIs/ARB and aspirin are still controversial. CCBs are associated with depression, but it is unclear whether it is beneficial or harmful. No association has been found with β-blockers, diuretics, and nitrates.

Topics: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Calcium Channel Blockers; Cardiovascular Agents; Cardiovascular Diseases; Depression; Humans; Hypertension; Renin-Angiotensin System

Monoterpenes are one of the most studied plant's secondary metabolites, they are found abundantly in essential oils of aromatic plants. They also have a great range of pharmacological properties, such as antihypertensive, bradycardic, antiarrhythmic and hypotensive. In the face of the burden caused by cardiovascular disease (CVDs) worldwide, studies using monoterpenes to assess their cardiovascular effects have increased over the years.. This systematic review aimed to summarize the use of monoterpenes in animal models of any CVDs.. PubMed, SCOPUS, LILACS and Web of Science databases were used to search for articles that used monoterpenes, in any type of administration, to treat or prevent CVDs in animal models. The PRISMA guidelines were followed. Two independent researchers extracted main characteristics of studies, methods and outcomes. Data obtained were analyzed qualitatively and quantitatively.. At the ending of the search process, 33 articles were selected for the systematic review. Of these, 17 articles were included in the meta-analysis. A total of 16 different monoterpenes were found for the treatment of hypertension, myocardial infarction, pulmonary hypertension, cardiac hypertrophy and arrhythmia. The main actions include hypotension, bradycardia, vasodilatation, antiarrhythmic, and antioxidant and antiapoptotic properties. From our data, it can be suggested that monoterpenes may be a significant source for new drug development. However, there is still a need to apply these knowledge into clinical research and a long path to pursue before putting them in the market.. The variability of cardiovascular effects demonstrated by the monoterpenes highlighted them as a promising candidates for treatment or prevention of CVDs. Nevertheless, studies that investigate their biological sites of action needs to be further encouraged.

Topics: Animals; Cardiovascular Agents; Cardiovascular Diseases; Disease Models, Animal; Humans; Hypertension; Monoterpenes; Myocardial Infarction; Oils, Volatile; Plants

The use of medicinal plants as a therapy alternative is old as human existence itself. Nowadays, the search for effective molecules for chronic diseases treatments has increased. The cardiometabolic disorders still the main cause of death worldwide and plants may offer potential pharmacological innovative approaches to treat and prevent diseases. In the range of plant molecules are inserted the terpenes, which constituent essential elements with several pharmacological characteristics and applications, including cardiovascular and metabolic properties. Thus, the aim of the present review is to update the terpenes use on chronic disorders such as obesity, diabetes, hypertension and vascular conditions. The review includes a brief terpenes description based on the scientific literature in addition to data collected from secondary sources such as books and conference proceedings. We concluded that terpenes could act as adjuvant or main alternative treatment (when started earlier) to improve cardiometabolic diseases, contributing to reduce side effects of conventional drugs, in addition to preserving ethnopharmacological knowledge.

Topics: Animals; Anti-Inflammatory Agents; Atherosclerosis; Cardiovascular Agents; Chemotherapy, Adjuvant; Diabetes Mellitus; Disease Models, Animal; Ethnopharmacology; Humans; Hypertension; Obesity; Plant Extracts; Plants, Medicinal; Stereoisomerism; Terpenes

Inflammation is an obligatory marker of arterial disease, both stemming from the inflammatory activity of cholesterol itself and from well-established molecular mechanisms. Raised progenitor cell recruitment after major events and clonal hematopoiesis related mechanisms have provided an improved understanding of factors regulating inflammatory phenomena. Trials with inflammation antagonists have led to an extensive evaluation of biomarkers such as the high sensitivity C reactive protein (hsCRP), not exerting a causative role, but frequently indicative of the individual cardiovascular (CV) risk. Aim of this review is to provide indication on the anti-inflammatory profile of agents of general use in CV prevention, i.e. affecting lipids, blood pressure, diabetes as well nutraceuticals such as n-3 fatty acids. A crucial issue in the evaluation of the benefit of the anti-inflammatory activity is the frequent discordance between a beneficial activity on a major risk factor and associated changes of hsCRP, as in the case of statins vs PCSK9 antagonists. In hypertension, angiotensin converting enzyme inhibitors exert an optimal anti-inflammatory activity, vs the case of sartans. The remarkable preventive activity of SLGT-2 inhibitors in heart failure is not associated with a clear anti-inflammatory mechanism. Finally, icosapent ethyl has been shown to reduce the CV risk in hypertriglyceridemia, with a 27 % reduction of hsCRP. The inflammation-based approach to arterial disease has considerably gained from an improved understanding of the clinical diagnostic strategy and from a better knowledge on the mode of action of numerous agents, including nutraceuticals.

Topics: Animals; Anti-Inflammatory Agents; Antihypertensive Agents; Cardiovascular Agents; Cardiovascular Diseases; Cardiovascular System; Diabetes Mellitus; Dietary Supplements; Dyslipidemias; Gastrointestinal Microbiome; Heart Disease Risk Factors; Humans; Hypertension; Hypoglycemic Agents; Hypolipidemic Agents; Inflammation; Inflammation Mediators; Risk Assessment; Signal Transduction

Hypertension and cardiovascular diseases (CVD) are very common conditions and account for significant medical disability and death worldwide. Therefore, their successful management is very critical for the prevention of the significant cardiovascular and socioeconomic consequences arising from their poor management.. These new chemical entities have different mechanisms of action and in preliminary studies have been successful in the treatment of hypertension, CVD, heart failure, stroke, and type 2 diabetes mellitus. These drugs can be used either alone or in combination with other antihypertensive and cardiovascular drugs. Hopefully, these new classes of cardiovascular drugs would be effective for the treatment of hypertension and CVD and decrease their socioeconomic consequences.

Topics: Animals; Antihypertensive Agents; Cardiovascular Agents; Cardiovascular Diseases; Drug Development; Drug Discovery; Humans; Hypertension

: Pharmacological treatment recommended by guidelines for very high-risk patients with established cardiovascular disease (CVD) includes lipid-lowering drugs, antihypertensive agents and antiplatelet therapy. Depending on the associated comorbidities, this baseline regimen has to be complemented with other drugs. Therefore, the number of pills to be taken is usually high and adherence to these multiple pill therapeutic regimens and long-term persistence on treatment is low, being the main factor for insufficient control of cardiovascular risk factors. The CNIC (Centro Nacional de Investigaciones Cardiovasculares, Ministerio de Ciencia e Innovación, España) polypill is the only polypill containing low-dose aspirin approved by the EMA and marketed in Europe, and has demonstrated to improve adherence. For this reason, guidelines recommend its use for secondary prevention of CVD, and also for primary prevention of cardiovascular events in patients with multiple cardiovascular risk factors and advanced atherosclerotic process at high risk of thrombosis and low risk of bleeding. This article pretends to simplify the steps that clinicians may follow to switch from any baseline regimen to the polypill with the use of several algorithms and tables showing the equivalent effective daily doses of different angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and statins to facilitate switching, as well as the steps to be followed depending of the initial levels of BP and LDL-cholesterol values to achieve BP and lipid control with the association to the polypill of other BP-lowering or lipid-lowering drugs whenever needed.

Topics: Cardiovascular Agents; Cardiovascular Diseases; Drug Combinations; Humans; Hypertension; Practice Guidelines as Topic; Primary Prevention; Secondary Prevention

Reactive oxygen species (ROS) are natural byproducts of oxygen metabolism in the cell. At physiological levels, they play a vital role in cell signaling. However, high ROS levels cause oxidative stress, which is implicated in cardiovascular diseases (CVD) such as atherosclerosis, hypertension, and restenosis after angioplasty. Despite the great amount of research conducted to identify the role of ROS in CVD, the image is still far from being complete. A common event in CVD pathophysiology is the switch of vascular smooth muscle cells (VSMCs) from a contractile to a synthetic phenotype. Interestingly, oxidative stress is a major contributor to this phenotypic switch. In this review, we focus on the effect of ROS on the hallmarks of VSMC phenotypic switch, particularly proliferation and migration. In addition, we speculate on the underlying molecular mechanisms of these cellular events. Along these lines, the impact of ROS on the expression of contractile markers of VSMCs is discussed in depth. We conclude by commenting on the efficiency of antioxidants as CVD therapies.

Topics: Angiotensin II; Antioxidants; Atherosclerosis; Biomarkers; Cardiovascular Agents; Cell Cycle Proteins; Cell Movement; Cell Proliferation; Fibroblast Growth Factors; Gene Expression Regulation; Graft Occlusion, Vascular; Humans; Hypertension; Muscle, Smooth, Vascular; Myocytes, Smooth Muscle; NADPH Oxidases; Oxidative Stress; Phenotype; Reactive Oxygen Species; Signal Transduction

A wide range of histone deacetylase (HDAC) inhibitors have been studied for their therapeutic potential because the excessive activity and expression of HDACs have been implicated in the pathogenesis of cardiac diseases. An increasing number of preclinical studies have demonstrated the cardioprotective effects of numerous HDAC inhibitors, suggesting a wide variety of mechanisms by which the inhibitors protect against cardiac stress, such as the suppression of cardiac fibrosis and fetal gene expression, enhancement of angiogenesis and mitochondrial biogenesis, prevention of electrical remodeling, and regulation of apoptosis, autophagy, and cell cycle arrest. For the development of isoform-selective HDAC inhibitors with high efficacy and low toxicity, it is important to identify and understand the mechanisms responsible for the effects of the inhibitors. This review highlights the preclinical effects of HDAC inhibitors that act against Zn

Topics: Animals; Antihypertensive Agents; Atrial Fibrillation; Blood Pressure; Cardiomegaly; Cardiovascular Agents; Fibrosis; Heart Rate; Histone Deacetylase Inhibitors; Histone Deacetylases; Humans; Hypertension; Myocardial Infarction; Myocardium; Signal Transduction; Ventricular Remodeling

Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome of exertional intolerance, cardiac dysfunction, and fluid overload and is associated with significant morbidity and mortality.. As our understanding of this syndrome has evolved, we are beginning to recognize the similarities and associations with chronic kidney disease (CKD). Salt and fluid retention are common in CKD and may be the sentinel event leading ultimately to the syndrome of HFpEF. Mechanisms linking both disease states include hypervolemia, inflammation, and endothelial dysfunction, which are also common to comorbidities that drive both HFpEF and CKD. In this review, we will discuss recent clinical research focusing on HFpEF, CKD, and comorbidities including hypertension and diabetes mellitus. We will review strategies for volume management and novel therapeutic approaches with new classes of drugs, including sodium-glucose cotransporters and angiotensin receptor/neprilysin inhibitors, which may work through targeting of both the heart and the kidney. Lastly, we emphasize why focusing on the alleviation of factors provoking renal injury and slowing the progression of renal dysfunction may provide the most therapeutic benefit in patients who have been diagnosed with HFpEF.

Topics: Cardiovascular Agents; Comorbidity; Diabetes Complications; Endothelium, Vascular; Heart Failure; Humans; Hypertension; Renal Insufficiency, Chronic; Risk Factors; Stroke Volume

Atrial fibrillation (AF) is the most common type of arrhythmia in the general population with a prevalence that reaches one third of patients with arterial hypertension. Several risk factors frequently associated with hypertension predispose the myocardium to AF by inducing atrial inflammation and fibrosis and altering atrial electrical and mechanical characteristics. AF influences the quality of life of hypertensive patients since it increases incidence of stroke and other thromboembolic events, and mortality. Polyunsaturated fatty acids of the ω-3 family (ω-3 PUFA) have been demonstrated to be beneficial in cardiovascular disease prevention by reducing plasma lipids and blood pressure levels and decreasing the risk of sudden death. These fatty acids can act as potent anti-inflammatory and anti-arrhythmic agents. Many studies have investigated a possible preventive effect of ω-3 PUFA on incident AF reporting contradictory results. This article overviews the evidence currently available on this important topic and provides some conclusive remarks on the possibility that these fatty acids could be beneficial in hypertensive patients.

Topics: Atrial Fibrillation; Cardiovascular Agents; Docosahexaenoic Acids; Eicosapentaenoic Acid; Fatty Acids, Omega-3; Fatty Acids, Unsaturated; Fibrosis; Humans; Hypertension; Incidence; Inflammation; Quality of Life; Risk Factors

Cardiovascular disease is now the leading cause of pregnancy-related deaths in the United States. Increasing maternal mortality in the United States underscores the importance of proper cardiovascular management. Significant physiological changes during pregnancy affect the heart's ability to respond to pathological processes such as hypertension and heart failure. These physiological changes further affect the pharmacokinetic and pharmacodynamic properties of cardiac medications. During pregnancy, these changes can significantly alter medication efficacy and metabolism. This article systematically reviews the literature on safety, efficacy, pharmacokinetics, and pharmacodynamics of cardiovascular drugs used for hypertension and heart failure during pregnancy and lactation. The 2017 American College of Cardiology/American Heart Association hypertension guidelines recommend transitioning pregnant patients to methyldopa, nifedipine, or labetalol. Heart failure medications, including beta-blockers, furosemide, and digoxin, are relatively safe and can be used effectively. Medications that block the renin angiotensin-aldosterone system have been shown to be beneficial in the general population; however, they are teratogenic and, therefore, contraindicated in pregnancy. Cardiovascular medications can also enter breast milk and, therefore, care must be taken when selecting drugs during the lactation period. A summary of the safety of drugs during pregnancy and lactation from an online resource, LactMed by the National Library of Medicine's TOXNET database, is included. High-risk pregnant patients with cardiovascular disease require a multispecialty team of doctors, including health care providers from obstetrics and gynecology, maternal fetal medicine, internal medicine, cardiovascular disease specialists, and specialized pharmacology expertise.

Topics: Breast Feeding; Cardiovascular Agents; Female; Heart Failure; Humans; Hypertension; Pregnancy; Pregnancy Complications, Cardiovascular; United States

Hypertension is a common comorbidity in patients with heart failure and most drugs that have demonstrated to improve prognosis in this population have the potential to reduce blood pressure. Nonetheless, the relationship between blood pressure and clinical outcomes and the relevance of blood pressure reduction in heart failure remains unclear. This narrative review summarises the evidence currently available to guide blood pressure treatment in this patient group and highlights key questions for further research. In patients with heart failure with reduced ejection fraction, guidelines consensually recommend treating hypertension with drugs that have compelling indications in heart failure, with a target blood pressure of 130/80 mmHg. In patients with heart failure with preserved ejection fraction, guidelines acknowledge that the optimal treatment strategy remains unclear and thus recommend adopting a similar treatment strategy to patients with reduced ejection fraction. In any case, low blood pressure should not deter uptitration of drugs otherwise indicated to improve prognosis in heart failure, provided that patients tolerate drugs without adverse events. In the absence of evidence for modification of treatment efficacy and safety by baseline blood pressure, it is likely that treatment may actually lead to higher absolute risk reduction in patients with the lowest blood pressure. Special considerations and treatment adjustments are needed in the elderly as well as in patients with diabetes, chronic kidney disease and atrial fibrillation. More evidence is needed on blood pressure management in patients with heart failure in general, in whom the increasing burden of multimorbidity adds further complexity to treatment.

Topics: Blood Pressure; Cardiovascular Agents; Heart Failure; Humans; Hypertension; Medication Therapy Management; Prognosis; Treatment Outcome

Male and female sexual dysfunction (SD) is considered a multifactorial condition. Numerous studies have shown the involvement of inflammatory processes in this pathological condition. Sexual intercourse requires healthy and functioning vessels to supply the pelvic region in both males and females, generating penile erection and clitoral and vaginal lubrication, respectively. Cardiovascular diseases and associated risk factors may contribute negatively to pelvic blood flow, possibly through immune system activation.. The study aimed to address the correlation between vascular inflammation driven by immune system activation and SD in males and females.. A literature review was performed to identify articles addressing male and female SD and vascular inflammation. Key words included "male and female sexual dysfunction," "vascular inflammation," "iliac and pudendal arteries dysfunction," "genitourinary tract," and "blood flow.". Management of systemic and local inflammation may be a useful alternative to improve SD and reduce the risk of cardiovascular diseases in the future.. Increased levels of cytokines and chemokines have been detected in humans and animals with hypertension, obesity, and diabetic conditions. Chronic activation of the innate immune system, especially by pathogen- or damage-associated molecular patterns, and metabolic-related disorders may act as triggers further contributing to an increased inflammatory condition. Due to the reduced size of vessels, SD and retinal vascular impairments have been shown to be predictive factors for cardiovascular diseases. Therefore, considering that blood flow to the genitalia is essential for sexual function, endothelial dysfunction and vascular remodeling, secondary to chronic immune system activation, may be implicated in male and female vasculogenic SD.. Several conditions appear to play a role in SD. In the present review, we have identified a role for the immune system in generating vascular and tissue impairments contributing to erectile dysfunction and female SD. Calmasini FB, Klee N, Webb RC, et al. Impact of Immune System Activation and Vascular Impairment on Male and Female Sexual Dysfunction. Sex Med Rev 2019;7:604-613.

Topics: Cardiovascular Agents; Cytokines; Diabetes Complications; Dyslipidemias; Female; Genitalia, Female; Genitalia, Male; Gonadal Steroid Hormones; Humans; Hypertension; Immune System Diseases; Immunity, Innate; Male; Obesity; Sexual Dysfunction, Physiological; Vascular Diseases; Vasculitis

Cardiovascular diseases are major complications in pregnancy worldwide and the number of patients who develop cardiac problems during pregnancy is increasing. Pregnancy-associated hypertensive complications such as pre-eclampsia (PE) or peripartum cardiomyopathy (PPCM) are potentially life-threatening heart diseases emerging during pregnancy, under delivery or in the first postpartal months in previously healthy women. Both disease entities display substantial morbidity and mortality in the acute phase. Long-term effects are just beginning to be evaluated. Pathophysiologies are not clear but may to some degree overlap with regard to angiogenic imbalance and endothelial damage. Genetics, lifestyle, and comorbidities are important modulators of PE and PPCM. The present review summarizes the current knowledge on epidemiology and pathophysiology, provides information on diagnostic and prognostic biomarkers and highlights promising novel therapeutic approaches for PE and PPCM.

Topics: Biomarkers; Cardiomyopathies; Cardiovascular Agents; Female; Humans; Hypertension; Peripartum Period; Pregnancy; Pregnancy Complications, Cardiovascular

Heart failure (HF) is a clinical syndrome of diverse etiologies and can be associated with preserved, reduced, or mid-range ejection fraction (EF). In the community, heart failure with preserved ejection fraction (HFpEF) is emerging as the most common form of HF. There remains considerable uncertainty regarding its pathogenesis, diagnosis, and optimal therapeutic approach. Hypotheses have been advanced to explain the underlying pathophysiology responsible for HFpEF, but to date, no specific therapy based on these hypotheses has been proven to improve outcomes in HFpEF. We provide a clinically focused review of the epidemiology, clinical presentation, diagnostic approach, pathophysiology, and treatment of HFpEF.

Topics: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Cardiovascular Agents; Dyspnea; Exercise Tolerance; Heart Failure; Hospitalization; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypertension; Incidence; Inflammation; Ivabradine; Mineralocorticoid Receptor Antagonists; Mortality; Nitrates; Phosphodiesterase 4 Inhibitors; Risk Factors; Stroke Volume

Heart failure affects more than 6 million people in the United States and incurs a heavy toll in morbidity, mortality, and health care costs. It frequently coexists with other important disorders, including hypertension, coronary artery disease, diabetes, and obesity. Decades of clinical trials have shown that several medications and interventions are effective for improving outcomes; however, mortality and hospitalization rates remain high. More recently, additional medications and devices have shown promise in reducing the health burden of heart failure.

Topics: Adrenergic beta-Antagonists; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Cardiac Rehabilitation; Cardiovascular Agents; Coronary Artery Disease; Defibrillators, Implantable; Diabetes Complications; Diagnostic Techniques, Cardiovascular; Digoxin; Diuretics; Heart Failure; Hospitalization; Humans; Hydralazine; Hypertension; Isosorbide Dinitrate; Ivabradine; Life Style; Mineralocorticoid Receptor Antagonists; Palliative Care; Primary Prevention; Referral and Consultation; Risk Factors

Hypertension is a leading cause of morbidity and mortality worldwide. A major pathophysiological factor contributing to hypertension is reduced nitric oxide (NO) bioavailability. Strategies to address this pathophysiological mechanism could offer significant advantages. Areas covered: In this review we aimed at examining a variety of drugs (statins, beta-adrenergic receptor blockers, calcium channel blockers, angiotensin converting enzyme inhibitors, angiotensin II type-1 receptor blockers) used to treat hypertension and other cardiovascular diseases, particularly with respect to their potential of increasing NO bioavailability and activity in the cardiovascular system. There is now evidence supporting the notion that many cardiovascular drugs activate NO signaling or enhance NO bioavailability as a contributing mechanism to their beneficial cardiovascular effects. Moreover, other drugs may attenuate NO inactivation by superoxide and other reactive oxygen species by exerting antioxidant effects. More recently, the NO oxidation products nitrite and nitrate have been acknowledged as sources of NO after recycling back to NO. Activation of the nitrate-nitrite-NO pathway is an alternate pathway that may generate NO from both anions and exert antihypertensive effects. Expert opinion: In this review, we provide an overview of the possible mechanisms by which these drugs enhance NO bioavailability and help in the therapy of hypertension.

Topics: Animals; Antihypertensive Agents; Antioxidants; Cardiovascular Agents; Cardiovascular Diseases; Humans; Hypertension; Nitric Oxide; Reactive Oxygen Species

Prevalence of cardiovascular (CV) disease is increasing worldwide. One of the most important risk factors for CV disease is hypertension that is very often related to obesity and metabolic syndrome. The search for key mechanisms, linking high blood pressure (BP), glucose and lipid dysmetabolism together with higher CV risk and mortality, is attracting increasing attention. Cardiac natriuretic peptides (NPs), including ANP and BNP, may play a crucial role in maintaining CV homeostasis and cardiac health, given their impact not only on BP regulation, but also on glucose and lipid metabolism. The summa of all metabolic activities of cardiac NPs, together with their CV and sodium balance effects, may be very important in decreasing the overall CV risk. Therefore, in the next future, cardiac NPs system, with its two receptors and a neutralizing enzyme, might represent one of the main targets to treat these multiple related conditions and to reduce hypertension and metabolic-related CV risk.

Topics: Animals; Atrial Natriuretic Factor; Biomarkers; Blood Pressure; Cardiovascular Agents; Cardiovascular Diseases; Humans; Hypertension; Natriuretic Peptide, Brain; Prognosis; Receptors, Atrial Natriuretic Factor; Risk Assessment; Risk Factors; Signal Transduction

The increasing rate of cardiovascular diseases, the improved survival after the acute phase, the aging of the population and the implementation of primary prevention caused an exponential increase in outpatient cardiac performance, thereby making it difficult to maintain a balance between the citizen-patient request and the economic sustainability of the healthcare system. On the other side, the prescription of many diagnostic tests with a view to defensive medicine and the related growth of patients' expectations, has led several scientific societies to educational campaigns highlighting the concept that "less is more".The present document is aimed at providing the general practitioner with practical information about a prompt diagnosis of signs/symptoms (angina, dyspnea, palpitations, syncope) of the major cardiovascular diseases. It will also provide an overview about appropriate use of diagnostic exams (echocardiogram, stress test), about the appropriate timing of their execution, in order to ensure effectiveness, efficiency, and equity of the health system.

Topics: Algorithms; Ambulatory Care; Cardiovascular Agents; Clinical Decision-Making; Diagnostic Techniques, Cardiovascular; Disease Management; Dyspnea; Follow-Up Studies; Health Priorities; Heart Diseases; Humans; Hypertension; Outpatients; Practice Guidelines as Topic; Symptom Assessment; Time Factors

Consistent evidence of numerous studies substantiates the asleep blood pressure (BP) mean derived from ambulatory BP monitoring (ABPM) is both an independent and a stronger predictor of cardiovascular disease (CVD) risk than are daytime clinic BP measurements or the ABPM-determined awake or 24-hour BP means. Hence, cost-effective adequate control of sleep-time BP is of marked clinical relevance. Ingestion time, according to circadian rhythms, of hypertension medications of 6 different classes and their combinations significantly improves BP control, particularly sleep-time BP, and reduces adverse effects.

Topics: Antihypertensive Agents; Blood Pressure; Cardiovascular Agents; Circadian Rhythm; Disease Management; Drug Chronotherapy; Humans; Hypertension; Sleep

Cardiovascular diseases are a leading cause of death in developed and developing countries and decrease the quality of life, which has enormous social and economic consequences for the population. Recent studies on essential oils have attracted attention and encouraged continued research of this group of natural products because of their effects on the cardiovascular system. The pharmacological data indicate a therapeutic potential for essential oils for use in the treatment of cardiovascular diseases. Therefore, this review reports the current studies of essential oils chemical constituents with cardiovascular activity, including a description of their mechanisms of action.

Topics: Cardiovascular Agents; Cardiovascular Diseases; Humans; Hypertension; Oils, Volatile

Excess visceral adipose tissue is associated with increased risk of high blood pressure, lipid disorders, type 2 diabetes, and cardiovascular disease. Adipose tissue is an endocrine organ with multiple humoral and metabolic roles in regulating whole-body physiology. However, perivascular adipose tissue (PVAT) also plays a functional role in regulating the contractile state of the underlying smooth muscle cell layer. Work during the past decade has shown that this adipose-vascular coupling is achieved by production of numerous substances released from PVAT. Animal disease models have been instrumental in identifying biological and pathophysiological functions of this regulation. These studies have produced strong evidence that alterations in the paracrine control of PVAT in the regulation of arterial tone contribute to vascular dysfunction in obesity, hypertension, and cardiometabolic disease. Perivascular relaxing factors, or perhaps their putative targets, might represent exciting new targets for the prevention and treatment of cardiovascular and metabolic diseases.

Topics: Adipokines; Adipose Tissue; Animals; Cardiovascular Agents; Cardiovascular Diseases; Diabetes Mellitus, Type 2; Endothelium, Vascular; Humans; Hypertension; Hypoglycemic Agents; Muscle, Smooth, Vascular; Obesity

Primary neurodegenerative autonomic disorders are characterized clinically by loss of autonomic regulation of blood pressure. The clinical picture is dominated by orthostatic hypotension, but supine hypertension is also a significant problem. Autonomic failure can result from impairment of central autonomic pathways (multiple system atrophy) or neurodegeneration of peripheral postganglionic autonomic fibers (pure autonomic failure, Parkinson's disease). Pharmacologic probes such as the ganglionic blocker trimethaphan can help us in the understanding of the underlying pathophysiology and diagnosis of these disorders. Conversely, understanding the pathophysiology is crucial in the development of effective pharmacotherapy for these patients. Autonomic failure patients provide us with an unfortunate but unique research model characterized by loss of baroreflex buffering. This greatly magnifies the effect of stimuli that would not be apparent in normal subjects. An example of this is the discovery of the osmopressor reflex: ingestion of water increases blood pressure by 30-40 mm Hg in autonomic failure patients. Animal studies indicate that the trigger of this reflex is related to hypo-osmolality in the portal circulation involving transient receptor potential vanilloid 4 receptors. Studies in autonomic failure patients have also revealed that angiotensin II can be generated through noncanonical pathways independent of plasma renin activity to contribute to hypertension. Similarly, the mineralocorticoid receptor antagonist eplerenone produces acute hypotensive effects, highlighting the presence of non-nuclear mineralocorticoid receptor pathways. These are examples of careful clinical research that integrates pathophysiology and pharmacology to advance our knowledge of human disease.

Topics: Animals; Autonomic Agents; Autonomic Nervous System; Autonomic Nervous System Diseases; Baroreflex; Blood Pressure; Cardiovascular Agents; Cardiovascular System; Ganglionic Blockers; Humans; Hypertension; Hypotension; Neurotransmitter Agents; Nitric Oxide; Renin-Angiotensin System; Supine Position; Sympathomimetics; Vasoconstrictor Agents

Osteoporosis and cardiovascular diseases are epidemiologically associated. Calcification phenomena of atherosclerotic plaque involve cytokines and growth factors also involved in bone remodeling. Drugs given for either of these two conditions could act on these mechanisms. Can osteoporosis drugs have an influence on the occurrence of cardiovascular events? Conversely, can the treatment of hypertension alter the course of osteoporosis? It is possible that administration of high doses of calcium (1g/day) in patients who already have important dietary intake can increase the risk of myocardial infarction. Epidemiological studies show links between low serum vitamin D levels and cardiovascular disease but interventional studies show that vitamin D administration in moderately deficient subjects vitamin D does not prevent the occurrence of cardiovascular events. Cohort studies show a beneficial effect of beta-blockers and thiazides administered to hypertensive patients: they reduce by 20% risk of fracture of the proximal femur. Should we focus on these anti-hypertensive treatments for our patients with osteoporosis?

Topics: Adrenergic beta-Antagonists; Antihypertensive Agents; Bone Density Conservation Agents; Calcium; Calcium, Dietary; Cardiovascular Agents; Cardiovascular Diseases; Denosumab; Diphosphonates; Drug Interactions; Humans; Hypercalcemia; Hypertension; Myocardial Infarction; Osteoporosis; Sodium Chloride Symporter Inhibitors; Teriparatide; Vitamin D; Vitamin D Deficiency

It is important to know how to treat hypertension in patients with coronary artery disease (CAD). The reason for the review was to update this treatment and to discuss the 2015 American Heart Association/American College of Cardiology/American Society of Hypertension 2015 guidelines of treatment of hypertension in patients with CAD.. Studies between 1968 and 2015 were reviewed on treatment of hypertension in patients with CAD using a Medline search, and studies between 1977 and 2015 were reported. Hypertension should be treated with beta blockers and ACE inhibitors or angiotensin receptor blockers (ARBs). Long-acting nitrates are effective antianginal and anti-ischemic drugs. Calcium-channel blockers (CCBs) may be added if angina persists despite beta blockers and long-acting nitrates. The 2015 guidelines recommend that the blood pressure should be < 140/90 mm Hg in patients aged ≤ 80 years and the systolic blood pressure < 150 mm Hg if they are ≥ 80 years.. Hypertension in patients with CAD should be treated with beta blockers and ACE inhibitors or ARBs. Long-acting nitrates are effective antianginal and anti-ischemic drugs. CCBs may be added if angina persists despite beta blockers and long-acting nitrates. The blood pressure should be < 140/90 mm Hg in patients aged < 80 years and the systolic blood pressure < 150 mm Hg if they are ≥ 80 years.

Topics: Adrenergic beta-Antagonists; Angina Pectoris; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Calcium Channel Blockers; Cardiovascular Agents; Coronary Artery Disease; Drug Therapy, Combination; Humans; Hypertension; Mineralocorticoid Receptor Antagonists; Nitrates; Practice Guidelines as Topic; Risk Factors; United States

The incidence, prevalence, and hospitalization rates associated with cardiovascular diseases (CVDs) are projected to increase substantially in the world. Understanding of the biological and pathophysiological mechanisms of survival can help the researchers to develop new management modalities. Numerous experimental studies have demonstrated that mid-chain HETEs are strongly involved in the pathogenesis of the CVDs. Mid-chain HETEs are biologically active eicosanoids that result from the metabolism of arachidonic acid (AA) by both lipoxygenase and CYP1B1 (lipoxygenase-like reaction). Therefore, identifying the localizations and expressions of the lipoxygenase and CYP1B1 and their associated AA metabolites in the cardiovascular system is of major importance in understanding their pathological roles. Generally, the expression of these enzymes is shown to be induced during several CVDs, including hypertension and cardiac hypertrophy. The induction of these enzymes is associated with the generation of mid-chain HETEs and subsequently causation of cardiovascular events. Of interest, inhibiting the formation of mid-chain HETEs has been reported to confer a protection against different cardiac hypertrophy and hypertension models such as angiotensin II, Goldblatt, spontaneously hypertensive rat and deoxycorticosterone acetate (DOCA)-salt-induced models. Although the exact mechanisms of mid-chain HETEs-mediated cardiovascular dysfunction are not fully understood, the present review proposes several mechanisms which include activating G-protein-coupled receptor, protein kinase C, mitogen-activated protein kinases, and nuclear factor kappa B. This review provides a clear understanding of the role of mid-chain HETEs in the pathogenesis of cardiovascular diseases and their importance as novel targets in the treatment for hypertension and cardiac hypertrophy.

Topics: Animals; Cardiomegaly; Cardiovascular Agents; Cardiovascular System; Cytochrome P-450 CYP1B1; Cytochrome P-450 Enzyme Inhibitors; Drug Design; Humans; Hydroxyeicosatetraenoic Acids; Hypertension; Lipoxygenase; Lipoxygenase Inhibitors; Molecular Targeted Therapy; Signal Transduction

Topics: Cardiovascular Agents; Drug-Related Side Effects and Adverse Reactions; Female; Heart Diseases; Humans; Hypertension; Male; Needs Assessment; Sex Factors; Treatment Outcome

The metabolic syndrome is a multiplex risk factor for atherosclerotic cardiovascular disease and type 2 diabetes. It is composed of atherogenic dyslipidemia, elevated blood pressure, insulin resistance and elevated glucose, a pro-thrombotic state, and a pro-inflammatory state. Excess energy intake and concomitant obesity are the major drivers of the syndrome. Lifestyle intervention can reverse metabolic risk factors, but at times, drug therapies or bariatric surgery may be required to control more overt risk factors.

Topics: Atherosclerosis; Bariatric Surgery; Cardiovascular Agents; Dyslipidemias; Humans; Hyperglycemia; Hypertension; Hypoglycemic Agents; Hypolipidemic Agents; Metabolic Syndrome; Obesity; Risk Factors; Risk Reduction Behavior; Treatment Outcome

Myocardial hypertrophic remodeling is a pathophysiological feature of several cardiac conditions and is the hallmark of hypertrophic cardiomyopathy (HCM), the most common monogenic inherited disease of the heart. In recent years, preclinical and clinical studies investigated the underlying molecular mechanisms and intracellular signaling pathways involved in pathologic cardiomyocyte hypertrophy and highlighted a number of possible molecular targets of therapy aimed at preventing its development. Early prevention of myocardial hypertrophic remodeling is particularly sought after in HCM, as current therapeutic strategies are unable to remove the primary cause of disease, i.e. the disease-causing gene mutation. Studies on transgenic animal models or human myocardial samples from patients with HCM identified intracellular calcium overload as a central mechanism driving pathological hypertrophy. In this review, we analyze recent preclinical and clinical studies on animal models and patients with HCM aimed at preventing or modifying hypertrophic myocardial remodeling. Mounting evidence shows that prevention of pathological hypertrophy is a feasible strategy in HCM and will enter the clinical practice in the near future. Considering the close mechanistic similarities between HCM and secondary hypertrophy, these studies are also relevant for the common forms of cardiac hypertrophy, such as hypertensive or valvular heart disease.

Topics: Calcium Channel Blockers; Cardiomyopathy, Hypertrophic; Cardiovascular Agents; Evidence-Based Medicine; Feasibility Studies; Genetic Predisposition to Disease; Heart Valve Diseases; Humans; Hypertension; Myocardium; Myocytes, Cardiac; Risk Factors; Signal Transduction; Treatment Outcome; Ventricular Remodeling

Peripartum cardiomyopathy is a potentially life-threatening pregnancy-associated disease that typically arises in the peripartum period and is marked by left ventricular dysfunction and heart failure. The disease is relatively uncommon, but its incidence is rising. Women often recover cardiac function, but long-lasting morbidity and mortality are not infrequent. Management of peripartum cardiomyopathy is largely limited to the same neurohormonal antagonists used in other forms of cardiomyopathy, and no proven disease-specific therapies exist yet. Research in the past decade has suggested that peripartum cardiomyopathy is caused by vascular dysfunction, triggered by late-gestational maternal hormones. Most recently, information has also indicated that many cases of peripartum cardiomyopathy have genetic underpinnings. We review here the known epidemiology, clinical presentation, and management of peripartum cardiomyopathy, as well as the current knowledge of the pathophysiology of the disease.

Topics: Bromocriptine; Cardiomyopathies; Cardiovascular Agents; Disease Susceptibility; Female; Heart Failure; Heart Transplantation; Hormones; Humans; Hypertension; Incidence; Infant, Newborn; Lactation; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy, Multiple; Puerperal Disorders

Topics: Atrial Fibrillation; Benzazepines; Bradycardia; Cardiovascular Agents; Drug Costs; Heart Failure; Humans; Hypertension; Ivabradine; Treatment Outcome

Hypertension (HTN) is a well-known health problem associated with considerable morbidity and mortality and it is an important risk factor for the development of heart failure (HF). These findings support the need for optimizing the antihypertensive strategies to prevent the progression to HF. Interestingly, the progression from HTN to HF, among other things, may be a consequence of inappropriate over-activation of the renin-angiotensin-aldosterone system (RAAS), sympathetic nervous system (SNS), and the natriuretic peptide system (NPS). In the present review, we will discuss the pathophysiological aspects of the progression from HTN to HF with reduced ejection fraction (HFrEF) and we will focus on the evolution of different pharmacological therapies which are reported to be effective in reducing BP and improving HF outcomes, paying particular attention to the recent trials that have demonstrated the efficacy of the combined therapy of RAAS blockade and Neprilysin (NEP) inhibitor in lowering BP and mediating several beneficial actions within cardiovascular tissues, such as avoiding the worsening of HF.

Topics: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Cardiovascular Agents; Disease Progression; Heart Failure; Humans; Hypertension; Neprilysin; Renin; Renin-Angiotensin System

Topics: Animals; Cardiovascular Agents; Cells, Cultured; Cyclooxygenase 2; Disease Models, Animal; Docosahexaenoic Acids; Epoprostenol; Gene Expression; Hypertension; Interleukin-1beta; Muscle, Smooth, Vascular; Nitric Oxide; Nitric Oxide Synthase Type II; Pressure; Rats, Inbred SHR; Rats, Inbred WKY

LCZ696, a first-in-class angiotensin receptor neprilysin inhibitor (ARNI), is comprised of the angiotensin receptor blocker valsartan and the neprilysin inhibitor pro-drug sacubitril (AHU377). After oral administration, AHU377 is rapidly metabolized to the active neprilysin inhibitor LBQ657. LCZ696 exerts its effects of diuresis, natriuresis, vasodilation and aldosterone secretion inhibition through simultaneous renin-angiotensin-aldosterone system (RAAS) blockade and natriuretic peptides system (NPS) enhancement. Powerful evidence including PARAMETER and PRARDIGM-HF trials have shown that LCZ696 outperforms RAAS inhibition in treating patients with hypertension and heart failure with reduced ejection fraction (HFrEF), and is well tolerated. In addition, accumulating evidence also suggests its potential use in heart failure with preserved ejection fraction (HFpEF), chronic kidney disease (CKD), post-myocardium infarction (post-MI) and stroke. Both the FDA and CHMP have approved LCZ696 for treatment of HFrEF. Despite all this, some special issues (e.g. use in specific subgroups, adverse events, contraindications and cost-effectiveness analysis) should be considered before its implementation in clinical practice.

Topics: Aminobutyrates; Angiotensin Receptor Antagonists; Animals; Biphenyl Compounds; Cardiovascular Agents; Contraindications; Cost-Benefit Analysis; Drug Combinations; Heart Failure; Humans; Hypertension; Myocardial Infarction; Renal Insufficiency, Chronic; Tetrazoles; Valsartan

The APJ is a class A, rhodopsin-like G protein-coupled receptor (GPCR) with high sequence similarity to the angiotensin receptor AT1. APJ has been shown to be widely expressed in humans tissues, including the central nervous system, cardiovascular system, adipocytes and others. APJ plays an important role in the occurrence and development of cardiovascular and metabolic diseases including atherosclerosis (AS), coronary heart disease (CAD), heart failure(HF), pulmonary arterial hypertension (PAH), myocardial hypertrophy and atrial fibrillation, especially hypertension. Previous researchers found that apelin/APJ could induce vasodilation and then reduce blood pressure. Despite APJ is closely associated with many diseases, there are no drugs that can activate or inhibit APJ directly. In the current review, we have summarized recently reported peptides, small molecule agonists and antagonists targeting APJ. Given the role of apelin/APJ in hypertension and other cardiovascular diseases, we believe that the peptides and compounds based on APJ will be developed for treatment of these diseases.

Topics: Apelin Receptors; Cardiovascular Agents; Cardiovascular Diseases; Drug Design; Humans; Hypertension; Molecular Structure; Molecular Targeted Therapy; Mutation; Receptors, G-Protein-Coupled; Signal Transduction; Small Molecule Libraries; Structure-Activity Relationship

Topics: Antihypertensive Agents; Benzazepines; Blood Pressure; Cardiovascular Agents; Heart Rate; Humans; Hypertension; Ivabradine; Randomized Controlled Trials as Topic

Recent large epidemiological studies have confirmed that an elevated resting heart rate is an independent predictor of cardiovascular and overall mortality in the general population as well as in patients with hypertension, coronary heart disease and chronic heart failure. Pathophysiological studies indicate that a higher heart rate has detrimental effects that favor myocardial ischemia, ventricular arrhythmias, as well as an increase in vascular oxidative stress, endothelial dysfunction and atherosclerosis progression. Benefits of heart rate lowering drugs, such as beta-blockers and ivabradine, in reducing overall and cardiovascular-related mortality, have been demonstrated particularly in patients with coronary heart disease and heart failure. However, despite these evidences, resting heart rate is still an overlooked cardiovascular risk factor.

Topics: Adrenergic beta-Antagonists; Arrhythmias, Cardiac; Atherosclerosis; Benzazepines; Cardiovascular Agents; Clinical Trials as Topic; Heart Failure; Heart Rate; Humans; Hypertension; Ivabradine; Myocardial Ischemia; Risk Factors

Peripartum cardiomyopathy is a form of heart failure occurring at the end of pregnancy or early in the postpartum period. Women may recover, have persistent cardiac dysfunction or suffer complications and death. Women who are African-American, older, hypertensive or have multiple gestation pregnancies have increased risk. Diagnosis and treatment may be delayed due to similarities between symptoms of normal pregnancy and heart failure. Echocardiography is essential for the diagnosis, and B-type natriuretic peptide can be helpful. Treatment for systolic heart failure must be adjusted during pregnancy, and anticoagulation may be indicated. Even after recovery, subsequent pregnancy confers substantial risk of worsening heart failure. Further investigations into the etiology, duration of treatment and risks for relapse are needed.

Topics: Age Factors; Black or African American; Breast Feeding; Cardiomyopathies; Cardiovascular Agents; Echocardiography; Female; Humans; Hypertension; Multiple Birth Offspring; Natriuretic Peptide, Brain; Peripartum Period; Pregnancy; Pregnancy Complications, Cardiovascular; Prognosis; Risk Factors; United States

The sympathetic nervous exerts a key role in cardiovascular homeostasis control by regulating cardiac output, systemic vascular resistance, heart rate and blood pressure.. Data collected during the past 30 years have unequivocally shown that in a considerable number of cardiovascular as well as noncardiovascular disease there is a marked activation of the sympathetic nervous system which exerts in the long-term period unfavourable haemodynamic, metabolic, cardiovascular and renal effects.. This paper will review the current knowledge on the alterations in sympathetic function described in cardiovascular disease, with particular focus on hypertension, heart failure and myocardial infarction.. The consequences of the phoenomenon will be discussed together with its therapeutic implications. This will be done by examining the impact of nonpharmacological as well as pharmacological interventions on sympathetic cardiovascular drive. The effects of new invasive approaches, such as carotid baroreceptor stimulation as well as renal nerves ablation, will be also briefly discussed.

Topics: Autonomic Nervous System Diseases; Cardiovascular Agents; Cardiovascular Diseases; Electric Stimulation Therapy; Heart Failure; Humans; Hypertension; Myocardial Infarction; Pressoreceptors; Sympathectomy

Topics: Cardiovascular Agents; Heart Failure; Humans; Hypertension; Natriuretic Peptides; Renin-Angiotensin System

The renin-angiotensin system (RAS) plays a major role in the pathophysiology of cardiovascular disorders. Angiotensin II (Ang-II), the final product of this pathway, is known for its vasoconstrictive and proliferative effects. Angiotensin-converting enzyme 2 (ACE2), a newly discovered homolog of ACE, plays a key role as the central negative regulator of the RAS. It diverts the generation of vasoactive Ang-II into the vasodilatory and growth inhibiting peptide angiotensin(1-7) [Ang(1-7)], thereby providing counter-regulatory responses to neurohormonal activation. There is substantial experimental evidence evaluating the role of ACE2/Ang(1-7) in hypertension, heart failure, and atherosclerosis. In this review, we aim to focus on the conceptual facts of the ACE2-Ang(1-7) axis with regards to clinical implications and therapeutic targets in cardiovascular disorders, with emphasis on the potential therapeutic role in cardiovascular diseases.

Topics: Angiotensin I; Angiotensin-Converting Enzyme 2; Cardiovascular Agents; Heart Failure; Humans; Hypertension; Molecular Targeted Therapy; Peptide Fragments; Peptidyl-Dipeptidase A; Renin-Angiotensin System; Ventricular Remodeling

The obstructive sleep apnoea syndrome (OSAS) had become a major public health concern in modern society due to its high prevalence but, above all, to its associated morbidity, especially cardiovascular.. Untreated OSAS is associated with an increased incidence of fatal (myocardial infarction and stroke) (odds ratio: 2.87) and non-fatal cardiovascular events (myocardial infarction, stroke, coronary artery bypass surgery and coronary angiography) (odds ratio: 3.17). Moreover, the prevalence of hypertension in patients with OSAS is high, between 35 and 80%. The pathophysiological mechanisms leading to these complications are mainly due to intermittent hypoxia secondary to repeated episodes of apnoea/hypopnoea during sleep. These mechanisms include sympathetic hyperactivation, impairment of vasomotor reactivity, vascular inflammation, oxidative stress and metabolic disorders. In patients with OSAS, the impact of continuous positive pressure is proven in terms of prevention of cardiovascular events although blood pressure reduction is limited. Obviously these effects are proportional to observance.. OSAS does increase the cardiovascular risk, independently of other risk factors. Although the impact of treatment is relatively low in decreasing blood pressure, it seems essentially effective in preventing cardiovascular morbidity. Therefore, OSAS screening, and the association of specific treatments in cardio-metabolic patients and OSAS patients respectively, should be included in clinical strategies.

Topics: Cardiovascular Agents; Cardiovascular Diseases; Cerebrovascular Disorders; Comorbidity; Continuous Positive Airway Pressure; Endothelium, Vascular; Glucose Intolerance; Humans; Hypertension; Hypoxia; Metabolic Syndrome; Nitric Oxide; Obesity; Oxidative Stress; Prevalence; Sleep Apnea, Obstructive; Sympathetic Nervous System; Vasculitis

Cardiovascular diseases (CVD) continue to represent the major cause of death, morbidity and healthcare expenditure worldwide. Current medical therapy fails to effectively halt disease progression and to reduce adverse clinical outcomes, reflecting incomplete understanding of pathomechanisms as well as the need to expand current pharmacotherapeutic strategies. Hypertension and heart failure, the most important CVD entities, are associated with imbalance in neurohormonal systems activity such as the renin-angiotensin-aldosterone system (RAAS), the sympathetic nervous system and the endothelin system. Blockade of the RAAS constitutes the most successful pharmacotherapeutic concept in hypertension and heart failure to date. The RAAS-opposing natriuretic peptide system constitutes the body's own BP-lowering system, and mediates a multitude of beneficial actions within cardiovascular tissues. The metallopeptidase neprilysin (NEP) hydrolyzes natriuretic peptides. Conceptually, NEP inhibition would increase salutary natriuretic peptide actions in CVD. However, stand-alone NEP inhibitors (NEPi) lacked efficacy beyond standard pharmacotherapy. Combined blockers of NEP and the endothelin system demonstrated efficacy in preclinical studies but have not been evaluated in clinical trials. A decade ago, omapatrilat and other dual-acting NEPi-ACEi (vasopeptidase-inhibitors) were promising agents for hypertension and heart failure. Despite greater efficacy, development of vasopeptidase-inhibitors was halted due to significant off-target effects in some cohorts, most notably increased frequency of angioedema in hypertensive subjects. Novel angiotensin-receptor-neprilysin-inhibitors (ARNi) seek to fully exploit clinical efficacy of combined RAAS-blockade and NEPi-mediated natriuretic peptide augmentation, and hopefully do so with improved clinical safety. We herein review current knowledge of NEPi as stand-alone and combined pharmacotherapeutic agents in hypertension and heart failure.

Topics: Animals; Blood Pressure; Cardiovascular Agents; Cardiovascular Diseases; Drug Design; Drug Therapy, Combination; Heart Failure; Humans; Hypertension; Neprilysin; Renin-Angiotensin System

Endothelins are endothelial peptides, the properties of which have been investigated for over 25 years. They play a special role in the pathophysiology of many diseases of the cardiovascular system. Endothelin-1, which is the most explored one, is a potent vasoconstrictor. It increases renal water and sodium excretion, augments cell growth and proliferation and has proinflammatory activity, by intensifying the production of reactive oxygen and nitrogen species (ROS and RNS). ET-1 takes part in the progression of such diseases as hypertension, atherosclerosis, heart and renal failure. The physio- and pathological effects of endothelins are mediated through ETA and ETB receptors. Blocking these receptors, in particular the ETA receptor, can prevent negative effects of endothelins. Long-term efforts to create drugs which act like that have brought relevant results. Endothelin receptor antagonists (ERA) are a new class of medicines, which are indicated in the treatment of pulmonary arterial hypertension. There are also optimistic results of trials with ERA administered in other disorders. On the basis of these data we may conclude that there will be more indications for this group of drugs. This review discusses properties and new research directions of ERA registered in pharmacotherapy.

Topics: Animals; Cardiovascular Agents; Cardiovascular Diseases; Drug Delivery Systems; Endothelin Receptor Antagonists; Humans; Hypertension

The official statistics of the Ministry of Health of the Russian Federation show that the past 10 years have been marked by an increase in the number of patients with chronic cerebral circulatory disorders (CCCD), accounting for at least 700 per 100,000 population. Hypertension is the most studied etiological factor of CCCD. However, its role is often perceived uniquely as the major mechanism for destabilization of the arterial vascular bed. The detailed study of the pathogenesis of impairments in the cerebral vascular bed and neurons will be able to predict the further course of the disease and to choose adequate therapy.

Topics: Brain Ischemia; Cardiovascular Agents; Cerebrovascular Circulation; Chronic Disease; Disease Management; Humans; Hypertension; Prognosis

Cardiovascular disease represents the main cause of death worldwide. Novel therapies to reduce elevated blood pressure and treat resistant hypertension, to consequently reduce the associated cardiovascular risk factors, are still required. Among the different strategies commonly used in medicinal chemistry to develop new molecules, the synthesis of multitarget/hybrid compounds combining two or more pharmacophore groups targeting simultaneously selected factors involved in cardiovascular diseases, has gained increasing interest. This review will focus on the most recent literature on multifunctional cardiovascular drugs, paying particular attention on hybrid compounds bearing natural scaffolds, considering that compounds derived from medicinal extracts are generally appealing for the medicinal chemist as they often bear the so-called "privileged structures". Moreover, taking into account many excellent reviews dealing with multitarget cardiovascular drugs published in the last few years, mainly devoted to RAAS inhibition and/or NO donors hybrid drugs, herein the most significant results obtained and the benefits and limitations of these approaches will be highlighted.

Topics: Animals; Cardiovascular Agents; Cardiovascular Diseases; Cardiovascular System; Drug Design; Humans; Hypertension; Molecular Targeted Therapy; Renin-Angiotensin System

Erectile dysfunction is common in the patient with cardiovascular disease. It is an important component of the quality of life and it also confers an independent risk for future cardiovascular events. The usual 3-year time period between the onset of erectile dysfunction symptoms and a cardiovascular event offers an opportunity for risk mitigation. Thus, sexual function should be incorporated into cardiovascular disease risk assessment for all men. A comprehensive approach to cardiovascular risk reduction (comprising of both lifestyle changes and pharmacological treatment) improves overall vascular health, including sexual function. Proper sexual counselling improves the quality of life and increases adherence to medication. This review explores the critical connection between erectile dysfunction and cardiovascular disease and evaluates how this relationship may influence clinical practice. Algorithms for the management of patient with erectile dysfunction according to the risk for sexual activity and future cardiovascular events are proposed.

Topics: Adult; Aged; Algorithms; Cardiovascular Agents; Cardiovascular Diseases; Diagnosis, Differential; Drug Interactions; Erectile Dysfunction; Exercise; Heart Failure; Humans; Hypertension; Impotence, Vasculogenic; Life Style; Male; Medical History Taking; Middle Aged; Phosphodiesterase 5 Inhibitors; Referral and Consultation; Risk Assessment; Risk Factors; Sex Counseling; Sexual Behavior; Sexual Dysfunctions, Psychological; Testosterone

There is increasing evidence that endothelin receptor blockade and, in particular, ET(A) receptor blockade not only confers protection against proteinuric renal disease in diabetes but also confers vasculoprotection.. Recent clinical trials using ET(A) receptor blockade in treating proteinuria and chronic kidney disease as well as atherosclerosis show great promise; however, adverse effects are still problematic.. Endothelin receptor blockade is associated with a significant attenuation of proteinuria and these effects are mediated in part via inhibition of inflammatory and oxidative stress related pathways as well profibrotic pathways. The addition of ET(A) receptor blockade to currently established therapies such as angiotensin-converting enzyme inhibitors or angiotensin receptor blockers may result in additional or synergistic renoprotection and vasculoprotection in hypertension and, in particular, in the context of diabetes.

Topics: Animals; Atherosclerosis; Cardiovascular Agents; Cardiovascular Diseases; Chronic Disease; Diabetic Nephropathies; Endothelin Receptor Antagonists; Endothelins; Humans; Hypertension; Kidney; Kidney Diseases; Proteinuria; Receptors, Endothelin; Signal Transduction

Approximately one in four ischemic strokes is of cardioembolic origin. Non-valvular atrial fibrillation accounts for 50% of these cases, followed by myocardial infarction, intraventricular thrombus, valvular heart disease and a miscellany of causes. The incidence of embolic heart disease in the population could be about 30 cases per 100,000 inhabitants per year, and its prevalence between 5 and 10 cases per 1,000 persons aged 65 years or older. Hospital mortality is high, and 5-year survival is only one out of every five patients. The recurrence rate of this type of stroke is about 12% at 3 months, higher than that of non-cardioembolic stroke. The severity of cardioembolic strokes and the resulting disability are greater than with non-cardioembolic stroke. Age, a history of stroke or transient ischemic attack, hypertension, diabetes and heart failure play a role in stroke with atrial fibrillation as additional risk factors for future embolisms. Stroke rates can reach over 20% per year and therefore the prevention and treatment of these events are of paramount importance.

Topics: Age Distribution; Atrial Fibrillation; Brain Damage, Chronic; Brain Ischemia; Cardiovascular Agents; Comorbidity; Diabetes Mellitus; Female; Heart Valve Diseases; Humans; Hypertension; Intracranial Embolism; Male; Myocardial Infarction; Prevalence; Recurrence; Risk Factors; Sex Distribution; Survival Rate; Thrombophilia

The purpose of this article is to describe the modern management of delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (SAH). SAH causes an inflammatory reaction to blood products in the basal cisterns of the brain, which may produce cerebral ischemia and strokes through progressive narrowing of the cerebral artery lumen. This process, known as cerebral vasospasm, is the most common cause of DCI after SAH. Untreated DCI may result in strokes, which account for a significant portion of the death and long-term disability after SAH.. A number of publications, including two recent consensus statements, have clarified many best practices for defining, diagnosing, monitoring, preventing, and treating DCI. DCI is best defined as new onset of focal or global neurologic deficits or strokes not attributable to another cause. In addition to the clinical examination, radiographic studies such as transcranial Doppler ultrasonography, CT angiography, and CT perfusion may have a role in determining which patients are at high risk for developing DCI. The mainstay of prevention and treatment of DCI is maintenance of euvolemia, which can be a difficult therapeutic target to measure. Hemodynamic augmentation with induced hypertension with or without inotropic support has become the first-line treatment of DCI. The ideal method of measuring hemodynamic values and volume status in patients with DCI remains elusive. In patients who do not adequately respond to or cannot tolerate hemodynamic augmentation, endovascular therapy (intraarterial vasodilators and balloon angioplasty) is a complementary strategy. Optimal triggers for escalation and de-escalation of therapies for DCI have not been well defined.. Recent guidelines and consensus statements have clarified many aspects of prevention, monitoring, and treatment of DCI after SAH. Controversies continue regarding the optimal methods for measurement of volume status, the role of invasive neuromonitoring, and the targets for hemodynamic augmentation therapy.

Topics: Angioplasty, Balloon; Brain Ischemia; Calcium Channel Blockers; Cardiovascular Agents; Cerebral Angiography; Combined Modality Therapy; Consensus Development Conferences as Topic; Disease Management; Fluid Therapy; Hemodynamics; Humans; Hypertension; Intracranial Aneurysm; Neuroimaging; Nimodipine; Practice Guidelines as Topic; Rupture, Spontaneous; Subarachnoid Hemorrhage; Ultrasonography, Doppler, Transcranial; Vasospasm, Intracranial

Topics: Animals; Atherosclerosis; Biomarkers; Cardiovascular Agents; Diabetes Complications; Dyslipidemias; Early Diagnosis; Fibrinolytic Agents; Global Health; Health Behavior; Health Care Costs; Homocysteine; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hyperhomocysteinemia; Hypertension; Magnetic Resonance Imaging; Medication Adherence; Plaque, Atherosclerotic; Risk Factors; Risk Reduction Behavior; Stents; Thrombosis; United States

The decision whether to treat individuals not previously known to have cardiovascular disease is based on a new risk table in which Dutch research data on morbidity have been incorporated. An explanation of the roles of additional risk factors ignored in the cardiovascular risk function, such as a sedentary lifestyle and a high BMI, is provided. A method for estimating the cardiovascular risk in patients with diabetes mellitus and rheumatoid arthritis has been developed. New recommendations concerning the measurement of blood pressure at home and in the ambulatory setting have been formulated. The recommendations for the choice of antihypertensive drugs have been revised. The recommendations on handling therapy-resistant hypertension are provided. Recommendations for choosing statins based on a current cost-effectiveness analysis are provided.

Topics: Antihypertensive Agents; Cardiovascular Agents; Cardiovascular Diseases; Cost-Benefit Analysis; Diabetes Mellitus, Type 2; Humans; Hypertension; Hypolipidemic Agents; Netherlands; Practice Guidelines as Topic; Risk Assessment; Risk Management

Pharmacological inhibitions of the renin-angiotensin-aldosterone system (RAAS) are crowned with one of the greatest success in the current field of cardiovascular medicine. In addition to the systemic effects including elevation of blood pressure and retention of sodium and water, sustained and excessive RAAS activation has direct and deleterious effects on a wide variety of tissues. Recent studies have deciphered the regulatory mechanisms underlying tissue RAAS activation at cellular and molecular levels, and suggested pathogenic roles of RAAS activation in hitherto unanticipated disorders such as muscular dystrophy, osteoporosis, cancer, and aging itself. Novel drugs targeting RAAS are under research and development in search for further efficacy, specificity, and even multifunctionality. This review will discuss the current progress and future perspective of RAAS research.

Topics: Angiotensin-Converting Enzyme Inhibitors; Cardiovascular Agents; Cardiovascular Diseases; Humans; Hypertension; Renin; Renin-Angiotensin System

Left ventricular hypertrophy (LVH) is a cardiovascular complication highly prevalent in patients with chronic kidney disease (CKD) and end-stage renal disease. LVH in CKD patients has generally a negative prognostic value, because it represents an independent risk factor for the development of arrhythmias, sudden death, heart failure and ischemic heart disease. LVH in CKD patients is secondary to both pressure and volume overload. Pressure overload is secondary to preexisting hypertension, but also to a loss of elasticity of the vessels and to vascular calcifications, leading to augmented pulse pressure. Anemia and the retention of sodium and water secondary to decreased renal function are responsible for volume overload, determining a hyperdynamic state. In particular, the correction of anemia with erythropoietin in CKD patients is advantageous, since it determines LVH reduction. Other risk factors for LVH in CKD patients are documented: some are specific to CKD, as mineral metabolism disorders (hypocalcemia, hyperphosphatemia, low serum vitamin D levels and secondary hyperparathyroidism), others are non-traditional, such as increased asymmetric dimethylarginine, oxidative stress, hyperhomocysteinemia and endothelial dysfunction that, in turn, accelerates the process of atherogenesis, triggers the inflammation and pro-thrombotic state of the glomerular and the vascular endothelium and aggravates the process of both CKD and LVH.

Topics: Anemia; Cardiovascular Agents; Cardiovascular System; Chronic Disease; Early Diagnosis; Early Medical Intervention; Hemodynamics; Humans; Hypertension; Hypertrophy, Left Ventricular; Kidney; Kidney Diseases; Kidney Function Tests; Metabolism; Risk Factors; Severity of Illness Index; Vascular Resistance; Water-Electrolyte Imbalance

Patients are considered to be at high risk of cardiovascular events if they have diabetes, chronic kidney disease, stroke, established coronary artery disease, or a coronary artery disease equivalent. Blood pressure-lowering therapy has been shown to reduce cardiovascular events in these patients significantly. Identification of high-risk patients by global risk evaluation is recommended for every hypertensive patient. Treatment of hypertension in high-risk patients with an angiotensin-converting enzyme inhibitor or an angiotensin receptor antagonist, with or without addition of a dihydropyridine calcium channel antagonist, is a reasonable approach based on current clinical trials.

Topics: Blood Pressure; Cardiovascular Agents; Cardiovascular Diseases; Drug Therapy, Combination; Evidence-Based Medicine; Humans; Hypertension; Patient Selection; Risk Assessment; Risk Factors; Treatment Outcome

Epoxyeicosatrienoic acids (EETs) are cytochrome P450 (CYP450) products of arachidonic acid and EETs are endogenous lipid mediators synthesized by the vascular endothelium which perform important biological functions, including vasodilation, anti-inflammation, antimigratory, and cellular signaling regulations. However, EETs are rapidly degraded by soluble epoxide hydrolase (sEH) to the corresponding diols: dihydroxyeicosatrienoic acids (DHETs), which have little active in causing vasorelaxation. A number of studies have supported that the inhibition of sEH (sEHIs) had cardiovascular protective effects in hypertension, cardiac hypertrophy, atherosclerosis, ischemia-reperfusion injury, and ischemic stroke. Moreover, sEHIs could slow the progression of inflammation, protect end-organ damage and prevent ischemic events, also, attenuate endothelial dysfunction, suggesting that the pharmacological blockade of sEH might provide a broad and novel avenue for the treatment of many cardiovascular diseases.

Topics: Animals; Brain Ischemia; Cardiomegaly; Cardiovascular Agents; Cardiovascular Diseases; Enzyme Inhibitors; Epoxide Hydrolases; Humans; Hypertension; Polymorphism, Genetic; Reperfusion Injury; Risk; Stroke

Stroke is a major cause of death and disability worldwide. Without improvements in prevention, the burden will increase during the next 20 years because of the ageing population, especially in developing countries. Major advances have occurred in secondary prevention during the past three decades, which demonstrate the broader potential to prevent stroke. We review the main medical treatments that should be considered for most patients with transient ischaemic attack or ischaemic stroke in the acute phase and the long term, and draw attention to recent developments.

Topics: Acute Disease; Anticoagulants; Antihypertensive Agents; Atrial Fibrillation; Brain Ischemia; Cardiovascular Agents; Cholesterol, HDL; Cholesterol, LDL; Chronic Disease; Developing Countries; Dyslipidemias; Fibrinolytic Agents; Humans; Hypertension; Hypolipidemic Agents; Ischemic Attack, Transient; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors; Secondary Prevention; Stroke; Time Factors; Triage

This review examines how the sympathetic nervous system plays a major role in the regulation of cardiovascular function over multiple time scales. This is achieved through differential regulation of sympathetic outflow to a variety of organs. This differential control is a product of the topographical organization of the central nervous system and a myriad of afferent inputs. Together this organization produces sympathetic responses tailored to match stimuli. The long-term control of sympathetic nerve activity (SNA) is an area of considerable interest and involves a variety of mediators acting in a quite distinct fashion. These mediators include arterial baroreflexes, angiotensin II, blood volume and osmolarity, and a host of humoral factors. A key feature of many cardiovascular diseases is increased SNA. However, rather than there being a generalized increase in SNA, it is organ specific, in particular to the heart and kidneys. These increases in regional SNA are associated with increased mortality. Understanding the regulation of organ-specific SNA is likely to offer new targets for drug therapy. There is a need for the research community to develop better animal models and technologies that reflect the disease progression seen in humans. A particular focus is required on models in which SNA is chronically elevated.

Topics: Animals; Cardiovascular Agents; Heart Diseases; Humans; Hypertension; Sympathetic Nervous System

The unique pathophysiology of heart failure with a preserved ejection fraction (HF-PEF) and the involvement of hypertension in its development are only poorly understood. The upregulation of the renin-angiotensin-aldosterone system (RAAS) has been identified as a key pathologic pathway contributing to fibrosis, cardiomyocyte abnormalities, inflammation, and endothelial dysfunction, all of which have been implicated in the progression of hypertension to HF-PEF. In addition, pharmacologic inhibition of the RAAS has been shown in animal models of diastolic dysfunction and in clinical trials to reduce these deleterious processes and to improve diastolic function. Despite these data, clinical trials performed with RAAS inhibitors in patients with HF-PEF have failed to demonstrate morbidity and mortality benefits. To date, there is no proven effective therapy specifically for HF-PEF. The deleterious effects of hypertension on mechanisms underlying the development of HF-PEF underscore the importance of effective and early control of hypertension for the prevention of HF-PEF.

Topics: Cardiovascular Agents; Clinical Trials as Topic; Diastole; Disease Progression; Heart Failure; Humans; Hypertension; Prognosis; Stroke Volume

Topics: Animals; Cardiovascular Agents; Clinical Trials as Topic; Crataegus; Evidence-Based Medicine; Heart Failure; Humans; Hyperlipidemias; Hypertension; Phytotherapy; Plant Extracts; Protective Agents

Topics: Adrenergic Agents; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Cardiovascular Agents; Chronic Disease; Diuretics; Drug Therapy, Combination; Humans; Hypertension; Renin

Aldosterone is an adrenal hormone that regulates sodium, fluid, and potassium balance. Jerome Conn first described the syndrome of autonomous and excessive aldosterone secretion or "primary aldosteronism." Contrary to the historical belief, recent studies indicate that primary aldosteronism is a common cause of hypertension with a prevalence of 5-10% among general hypertensive patients. Various animal models have demonstrated that aldosterone in association with a high salt diet results in target-organ inflammation and fibrosis. Similarly, cross-sectional and observational human studies have demonstrated the association of aldosterone with development and severity of hypertension, congestive heart failure, coronary artery disease, chronic kidney disease, and metabolic syndrome. Several interventional studies have also demonstrated the beneficial effects of mineralocorticoid receptor antagonists in these disease processes, particularly hypertension, heart failure, and post myocardial infarction, further supporting the role of aldosterone in their pathogenesis. We review the role of aldosterone in these various cardiovascular disease processes along with potential mechanisms and treatment.

Topics: Adrenalectomy; Aldosterone; Animals; Antihypertensive Agents; Cardiovascular Agents; Cardiovascular Diseases; Heart Failure; Humans; Hyperaldosteronism; Hypertension; Kidney Diseases; Metabolic Syndrome; Mineralocorticoid Receptor Antagonists; Treatment Outcome

Cardioembolic stroke accounts for one third of all ischemic strokes, and atrial fibrillation (AF) is the cardiac source of emboli in 50% of them. However, the absolute risk of stroke associated with AF has enormous variability, and several clinical risk stratification schemes have been proposed. One of the most validated and used in clinical practice is the CHADS2 index, characterized by its simplicity and rapid application. Current recommendations about antithrombotic therapy in AF patients are based on assessment of annual risk of stroke; thus, antiaggregation is indicated in patients with a low risk, and anticoagulation is prescribed when annual risk is greater than 2.5%. Relevant studies comparing rate and rhythm control do not defend achievement and maintenance of sinus rhythm as a routine management of AF patients and demonstrate that rate control is comparable or even better than rhythm control in terms of survival and quality of life. Optimal control of blood pressure is a relevant factor in preventing cardioembolic stroke in AF patients, because hypertension multiplies the risk of stroke by 12. Antihypertensive drugs such as angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers proved to reduce AF recurrences, especially in the context of left ventricular dysfunction and ventricular hypertrophy.

Topics: Anti-Arrhythmia Agents; Anticoagulants; Antihypertensive Agents; Atrial Fibrillation; Cardiovascular Agents; Embolism; Fibrinolytic Agents; Heart Diseases; Humans; Hypertension; Patient Care Team; Patient Selection; Platelet Aggregation Inhibitors; Practice Guidelines as Topic; Risk Assessment; Risk Factors; Secondary Prevention; Stroke; Treatment Outcome

Topics: Acute Coronary Syndrome; Aged; Cardiovascular Agents; Humans; Hypertension; Intraoperative Period; Male; Myocardial Infarction; Tachycardia

This review aims to update the practitioner in recent developments in the treatment of hypertension in children and adolescents.. In the last years, the treatment of hypertension in children and adolescents has been characterized by an improvement in the definition of hypertension and the more widespread use of the 24-h blood pressure monitor to define the hypertension pattern and assess efficacy of the therapy. A few studies on the use of converting enzyme inhibitors and angiotensin II receptor blocker emphasizing doses, efficacy, and side effects have been published. Of special interest is the tantalizing hypothesis on the role of uric acid in essential hypertension and the practical application of the use of allopurinol as monotherapy for this condition.. The authors aim to convey the need to define the blood pressure pattern in these patients before any type of therapy is started and the titration of medications according to the pathophysiologic mechanisms involved.

Topics: Adolescent; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Blood Pressure Monitoring, Ambulatory; Cardiovascular Agents; Child; Diet; Diuretics; Exercise; Humans; Hypertension

The 57th Annual Scientific Session of the American College of Cardiology was held in Chicago (IL, USA) between 29 March and 1 April 2008. It was attended by nearly 30,000 participants from around the world. The conference was highlighted by the presentation of 13 late-breaking clinical trials and 13 late-breaking abstracts.

Topics: Antihypertensive Agents; Atherosclerosis; Biomarkers; Cardiovascular Agents; Cardiovascular Diseases; Diabetes Mellitus; Drug Therapy, Combination; Female; Humans; Hypercholesterolemia; Hypertension; Hypolipidemic Agents; Male; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; Sensitivity and Specificity; Survival Analysis; Treatment Outcome

Dementia is one of the most important neurological disorders in the elderly. Aging is associated with a large increase in the prevalence and incidence of degenerative (Alzheimer's disease) and vascular dementia, leading to a devastating loss of autonomy. In view of the increasing longevity of populations worldwide, prevention of dementia has turned into a major public health challenge. In the past decade, several vascular risk factors have been found to be associated with vascular dementia but also Alzheimer's disease. Some longitudinal studies, have found significant associations between hypertension, diabetus mellitus, and metabolic syndrome, assessed at middle age, and dementia. Studies assessing the link between hypercholesterolemia, atrial fibrillation, smoking, and dementia have given more conflicting results. Furthermore, some studies have highlighted the possible protective effect of antihypertensive therapy on cognition and some trials are evaluating the effects of statins and treatments for insulin resistance. Vascular risk factors and their treatments are a promising avenue of research for prevention of dementia, and further long-term, placebo-controlled, randomized studies, need to be performed.

Topics: Alzheimer Disease; Apolipoproteins E; Atrial Fibrillation; Cardiovascular Agents; Cardiovascular Diseases; Cognition; Dementia, Vascular; Diabetes Complications; Humans; Hypercholesterolemia; Hypertension; Metabolic Syndrome; Risk Factors; Smoking

Insulin resistance, cardiometabolic syndrome, and hypertension are common health problems with significant consequences for individuals and society. The pathogenesis of these disorders is complex and not fully understood. In this article we review the current knowledge about the effects of lifestyle modification and pharmacologic antihypertensive agents on insulin resistance and hypertension.

Topics: Adrenergic beta-Antagonists; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Cardiovascular Agents; Endothelium, Vascular; Humans; Hypertension; Inflammation; Insulin Resistance; Life Style; Mineralocorticoid Receptor Antagonists; Obesity; Renin; Renin-Angiotensin System

Soluble guanylyl cyclase (sGC) is one of the key enzymes of the nitric-oxide (NO)/cyclic 3',5'-guanosine monophosphate (cGMP) pathway. Located in virtually all mammalian cells, it controls the vessel tone, smooth muscle cell growth, platelet aggregation, and leukocyte adhesion. In vivo sGC activity is mainly regulated by NO which in turn is released from L-arginine by nitric oxide synthases. One of the main diseases of the cardiovascular system, endothelial dysfunction, leads to a diminished NO synthesis and thus increases vessel tone as well as the risk of thrombosis. The predominant therapeutic approach to this condition is a NO replacement therapy, as exemplified by organic nitrates, molsidomin, and other NO releasing substances. Recent advances in drug discovery provided a variety of other approaches to activate sGC, which may help to circumvent both the tolerance problem and some non-specific actions associated with NO donor drugs. Substances like BAY 41-2272 stimulate sGC in a heme-dependent fashion and synergize with NO, allowing to enhance the effects both of endogenous NO and of exogenous NO donors. On the other hand, heme-independent activators like BAY 58-2667 allow to activate sGC even if it is rendered unresponsive to NO due to oxidative stress or heme loss. Furthermore, a few substances have been described as specific inhibitors of sGC that allow to alleviate the effects of excess NO production as seen in shock. This review discusses the cardiovascular effects of heme-dependent and heme-independent activators as well as of inhibitors of sGC.

Topics: Animals; Atherosclerosis; Carbon Monoxide; Cardiovascular Agents; Cyclic GMP; Guanylate Cyclase; Humans; Hypertension; Hypertension, Pulmonary; Nitric Oxide; Nitric Oxide Donors; Signal Transduction

Trandolapril is a well known angiotensin converting enzyme (ACE) inhibitor with many cardiovascular (CV) indications. The objectives of this article are to review the pharmacokinetics and pharmacodynamics properties of trandolapril and to focus on its clinical relevance in cardiovascular medicine. Various populations have been studied in large clinical trials including patients with congestive heart failure (CHF) after an acute myocardial infarction (AMI), diabetics, patients with hypertension (HTN), stable coronary artery disease (CAD) and prevention of proteinuria. Long-term treatment with trandolapril in patients with reduced left ventricular function soon after AMI significantly reduced the risk of overall mortality, mortality from CV causes, sudden death, and the development of severe CHF. Treatment with trandolapril after AMI complicated by left ventricular dysfunction appears to be of considerable importance in patients with diabetes mellitus by saving lives and substantially reducing the risk of progression to severe CHF as well. Moreover, trandolapril reduces progression to proteinuria in high-risk patients. Some of the advantages of trandolapril over other ACE inhibitors are the wide spectrum of patient populations studied, the well established dosage and its proven trough-to-peak effect ratios permitting a safe once-a-day administration.

Topics: Angiotensin-Converting Enzyme Inhibitors; Cardiovascular Agents; Cardiovascular Diseases; Coronary Artery Disease; Diabetes Complications; Drug Administration Schedule; Heart Failure; Humans; Hypertension; Indoles; Myocardial Infarction; Proteinuria; Treatment Outcome; Ventricular Dysfunction, Left

Regardless of the type of arterial reconstruction, luminal narrowing (stenosis or restenosis) develops in approximately one third of the vessels. In the past, the focus of research has been on the mechanisms of stenosis (intimal hyperplasia, pathologic remodeling) and pharmacologic approaches to prevention. An alternative approach is to induce intimal atrophy after luminal narrowing has developed, thus limiting treatment to only those patients that develop a problem. This approach to treat established disease by reducing wall mass through induction of cell death and extracellular matrix removal would be particularly useful for treating stenosis in synthetic bypass grafts or stented vessels, in which intimal hyperplasia is the primary mechanism of stenosis. This approach may be applicable as well to other vascular proliferative disorders, such as pulmonary hypertension and chronic transplant arteriopathy. Proof of principle has been shown in experiments with antibodies to platelet-derived growth factor (PDGF) receptors that cause neointimal regression in baboon polytetrafluoroethylene (PTFE) grafts and with angiotensin-converting enzyme inhibitors that induce medial atrophy in hypertensive arteries. Possible molecular targets could include PDGF receptors, A20, and BMP4. Further studies are needed to determine the utility of such a therapeutic approach to vascular disease.

Topics: Animals; Arterial Occlusive Diseases; Atrophy; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Blood Vessels; Cardiovascular Agents; Cell Death; Cell Proliferation; Constriction, Pathologic; Coronary Disease; Disease Models, Animal; Heart Transplantation; Humans; Hyperplasia; Hypertension; Hypertrophy; Recurrence; Remission Induction; Signal Transduction; Stents

Peripheral arterial occlusive disease (PAD) is a highly prevalent atherosclerotic syndrome associated with significant morbidity and mortality. It is defined by atherosclerotic obstruction of the abdominal aorta and arteries to the legs that reduces arterial flow during exercise and/or at rest, and is a common manifestation of systemic atherosclerosis. PAD represents a marker for premature cardiovascular events, and in patients with PAD, even in the absence of a history of myocardial infarction (MI) or ischemic stroke, they have approximately the same relative risk of death from cardiovascular causes as do patients with a history of coronary or cerebrovascular disease. In addition, their death rate from all causes is approximately equal in men and women and is elevated even in asymptomatic patients. The major risk factors for PAD are the well defined atherosclerotic risks such as diabetes mellitus, cigarette smoking, advanced age, hyperlipidemia, and hypertension. Due to the presence of these risk factors, the systemic nature of atherosclerosis, and the high risk of ischemic events, patients with PAD should be candidates for aggressive secondary prevention strategies including aggressive risk factor modification, antiplatelet therapy, lipid lowering therapy and antihypertensive treatment. This article reviews the current medical treatment and risk factor modification of patients with PAD.

Topics: Age Factors; Atherosclerosis; Cardiovascular Agents; Cardiovascular Diseases; Diabetes Complications; Disease Progression; Drugs, Investigational; Exercise Therapy; Female; Humans; Hyperhomocysteinemia; Hyperlipidemias; Hypertension; Inflammation; Intermittent Claudication; Male; Peripheral Vascular Diseases; Renal Insufficiency, Chronic; Risk Factors; Smoking; Smoking Cessation; Treatment Outcome

In contrast with the short research history of the enzymatic synthesis of nitric oxide (NO), the introduction of nitrate-containing compounds for medicinal purposes marked its 150th anniversary in 1997. Glyceryl trinitrate (nitroglycerin) is the first compound of this category. On October 12, 1998, the Nobel Assembly awarded the Nobel Prize in Medicine or Physiology to scientists Robert Furchgott, Louis Ignarro, and Ferid Murad for their discoveries concerning NO as a signaling molecule in the cardiovascular system. NO-mediated signaling is a recognized component in various physiologic processes (eg, smooth muscle relaxation, inhibition of platelet and leukocyte aggregation, attenuation of vascular smooth muscle cell proliferation, neurotransmission, and immune defense), to name only a few. NO has also been implicated in the pathology of many inflammatory diseases, including arthritis, myocarditis, colitis, and nephritis and a large number of pathologic conditions such as amyotrophic lateral sclerosis, cancer, diabetes, and neurodegenerative diseases. Some of these processes (eg, smooth muscle relaxation, platelet aggregation, and neurotransmission) require only a brief production of NO at low nanomolar concentrations and are dependent on the recruitment of cyclic guanosine monophosphate (cGMP)-dependent signaling. Other processes are associated with direct interaction of NO or reactive nitrogen species derived from it with target proteins and requires a more sustained production of NO at higher concentrations but do not involve the cGMP pathway.

Topics: Atherosclerosis; Cardiovascular Agents; Cardiovascular Diseases; Cardiovascular System; Endothelium; Humans; Hypertension; Nitric Oxide; Reactive Nitrogen Species; Reactive Oxygen Species; Signal Transduction

It is generally accepted that the increased cardiovascular morbidity and mortality in hypertension are related to target organ damage. Classically, the target organs are heart, brain, and kidneys. This brief report examines whether high arterial pressure may also affect other organs, such as aorta and large arteries. An attempt was also made to elucidate the relationship between disorders of the aorta and large arteries and other cardiovascular risk factors to the pathophysiology and treatment of patients with hypertension and its severe comorbid disease, atherosclerosis.

Topics: Arteries; Atherosclerosis; Blood Pressure; Cardiovascular Agents; Humans; Hypertension; Risk Factors; Vascular Resistance

The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study is the first, and, so far, the only endpoint trial in patients with hypertension and left ventricular hypertrophy (LVH) to show a divergent therapeutic outcome of one treatment modality over another with equivalent blood pressure control. The purpose of this article is to review post hoc sub-analyses of LIFE study data and other clinical studies that offer some insight into possible treatment-related differences contributing to the superior stroke outcome of losartan versus atenolol beyond blood pressure reduction.. Relevant randomized clinical trials and review articles were identified through a MEDLINE search of English-language articles published between 1990 and 2006 using the search terms losartan, atenolol, LIFE, hypertension, and LVH. Articles describing major clinical studies, new data, or mechanisms pertinent to the LIFE study were selected for review.. Differences in blood pressure or in the distribution of add-on medications were not evident between study groups in the LIFE study. Thus, the observed outcomes benefits favoring losartan may involve other possible mechanisms, including differential effects of losartan and atenolol on LVH regression, left atrial diameter, atrial fibrillation, brain natriuretic peptide, vascular structure, thrombus formation/platelet aggregation, serum uric acid, albuminuria, new-onset diabetes, and lipid metabolism. Alternative explanations for the LIFE study findings have also been put forward, including the choice of atenolol as an appropriate active comparator and differential effects between treatment groups on central pulse pressure. Additional clinical trials are needed to determine if the beneficial effects of losartan seen in LIFE are shared by other inhibitors of the renin-angiotensin system.. Sub-analyses of the LIFE study data suggest that losartan's stroke benefit may arise from a mosaic of mechanisms rather than a single action. Further studies are expected to continue to delineate the mechanisms of differential responses to treatments in LIFE.

Topics: Adrenergic beta-Antagonists; Angiotensin II Type 1 Receptor Blockers; Antihypertensive Agents; Atenolol; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Blood Pressure; Cardiovascular Agents; Cohort Studies; Drug Utilization; Endothelium, Vascular; Follow-Up Studies; Heart Atria; Humans; Hypertension; Hypertrophy, Left Ventricular; Losartan; Models, Biological; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Platelet Aggregation; Platelet Aggregation Inhibitors; Protein Precursors; Randomized Controlled Trials as Topic; Research Design; Risk; Risk Factors; Stroke; Thrombosis; Treatment Outcome

Diabetes mellitus (DM) is a worldwide epidemic. Its prevalence is rapidly increasing in both developing and developed countries. Coronary heart disease (CHD) is highly prevalent and is the major cause of morbidity and mortality in diabetic patients. The purpose of this review is to assess the clinical impact of recent advances in the epidemiology, prevention, and management of CHD in diabetic patients. A systematic review of publications in this area, referenced in MEDLINE in the past 5 years (2000 to 2005), was undertaken. Patients with CHD and prediabetic states should undergo lifestyle modifications aimed at preventing DM. Pharmacological prevention of DM is also promising but requires further study. In patients with CHD and DM, routine use of aspirin and an angiotensin-converting enzyme inhibitor (ACE-I)--unless contraindicated or not tolerated-and strict glycemic, blood pressure, and lipid control are strongly recommended. The targets for secondary prevention in these patients are relatively well defined, but the strategies to achieve them vary and must be individualized. Intense insulin therapy might be needed for glycemic control, and high-dose statin therapy might be needed for lipid control. For blood pressure control, ACE-Is and angiotensin receptor blockers are considered as first-line therapy. Noncompliance, particularly with lifestyle measures, and underprescription of evidence-based therapies remain important unsolved problems.

Topics: Angiotensin-Converting Enzyme Inhibitors; Aspirin; Cardiovascular Agents; Coronary Disease; Diabetes Mellitus, Type 2; Dyslipidemias; Health Behavior; Humans; Hyperglycemia; Hypertension; Insulin Resistance; Life Style; Metabolic Syndrome; Treatment Refusal

Peripheral arterial disease (PAD) is strongly associated with atherosclerosis in the coronary and carotid arteries, leading to a highly increased incidence of myocardial infarction, ischaemic stroke and cardiovascular death. Fortunately, pharmacological interventions in large clinical trials have been as effective in subgroups of patients with PAD as in subjects with other atherosclerotic disease. Antiplatelet treatment is indicated in virtually all patients with PAD. Aspirin 75-325 mg day(-1) is considered as first-line treatment, and clopidogrel 75 mg day(-1) is an effective alternative. Statin therapy is indicated to achieve a target low-density lipoprotein cholesterol level of < or = 2.5 mmol L(-1) in patients with PAD and there is emerging evidence that even lower levels are beneficial. Lowering of plasma homocysteine by supplementing folic acid, vitamin B(12) and vitamin B(6) is not recommended in patients with mild to moderate hyperhomocysteinaemia in the 12-25 micromol L(-1) range, since it does not reduce the incidence of cardiovascular events. Antihypertensive treatment is indicated to achieve a goal blood pressure of < or = 140/90 mmHg or < or = 130/80 mmHg in the presence of diabetes or chronic kidney disease. All classes of antihypertensive drugs are acceptable for treatment of hypertension in patients with PAD, but angiotensin-converting enzyme inhibitors ramipril or perindopril are especially appropriate because they reduce the incidence of cardiovascular events beyond their blood pressure-lowering effects. Beta-blockers should not be used as first-line antihypertensive treatment. Diabetic patients with PAD should reduce their glycosylated haemoglobin to < or = 7%. In conclusion, pharmacological secondary prevention of cardiovascular morbidity and mortality in patients with PAD should be as comprehensive as that in patients with established coronary or cerebrovascular disease.

Topics: Antihypertensive Agents; Aspirin; Cardiovascular Agents; Diabetic Angiopathies; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypercholesterolemia; Hyperhomocysteinemia; Hypertension; Peripheral Vascular Diseases; Platelet Aggregation Inhibitors; Risk Factors; Thrombosis

This paper will review the role of the sympathetic nervous system in the pathogenesis of the metabolic syndrome as well as its importance as target of non-pharmacologic and pharmacologic treatment.. Several indices of adrenergic drive, such as plasma norepinephrine, norepinephrine spillover from adrenergic nerve terminals and efferent postganglionic muscle sympathetic nerve traffic, have all shown an increase in the different conditions clustering in metabolic syndrome, such as obesity, hypertension and insulin resistance state. This increase: 1) appears to be potentiated in the metabolic syndrome; and 2) contributes to a large extent at the cardiovascular structural and functional alterations typical of the disease. Based on this evidence, non-pharmacologic life-style interventions as well as drug treatment procedures used in the therapeutic approach to the metabolic syndrome should be aimed at exerting not only favourable haemodynamic and metabolic effects but also pronounced sympathoinhibition.. The data reviewed in this paper strongly support the relevance of the sympathetic nervous system in the pathogenesis of the metabolic syndrome and the importance of the sympathomodulation as a specific aim of therapeutic intervention.

Topics: Adrenergic Fibers; Blood Pressure; Blood Vessels; Cardiomegaly; Cardiovascular Agents; Cardiovascular Diseases; Cardiovascular System; Health Behavior; Humans; Hypertension; Life Style; Metabolic Syndrome; Obesity; Risk Factors; Sympathetic Nervous System

Several systemic and cardiac diseases cause an impairment of left ventricular filling or of the ability to maintain cardiac output, without an increase in end-diastolic pressure. Prevalence of diastolic dysfunction has been found to be higher than systolic dysfunction in most studies. Many physiological conditions (age, sex and body weight), and pathological processes, such as cardiac or systemic diseases, can increase the incidence of diastolic dysfunction. Early diagnosis of left ventricular diastolic impairment has been demonstrated to have important therapeutic implications. Several invasive or non-invasive methods to investigate diastolic properties of the left ventricle have been described; a large number of studies compared different parameters of diastolic function in order to find the most accurate: this is of particular prognostic relevance since diastolic dysfunction may remain asymptomatic for a long period before resulting in overt heart failure. The purpose of this article is to provide an extensive review of the contemporary literature regarding diastolic function assessment and its role in daily practice.

Topics: Acute Disease; Angiotensin-Converting Enzyme Inhibitors; Cardiac Output, Low; Cardiomyopathy, Hypertrophic; Cardiovascular Agents; Diabetes Complications; Diastole; Echocardiography; Humans; Hypertension; Myocardial Ischemia; Pericarditis; Renin-Angiotensin System; Ventricular Dysfunction, Left; Ventricular Function, Left

In patients with acute coronary syndromes (ACS), hypertension is common. The type of ACS and severity of hypertension would determine the treatment algorithm. In ST elevation myocardial infarction (MI), time to reperfusion is essential whereas in malignant hypertension the reduction of blood pressure to prevent end organ damage is the priority. Many therapeutic drugs available for ACS and hypertension are commonly used to treat both these conditions simultaneously. Once the ACS is treated medically, revascularization therapy is likely to be considered. Importantly, optimization of hypertension management may prevent subsequent complications. In this review, we discuss the frequency of hypertension and ACS as single clinical conditions, as well as combined presentations. The pathophysiology of myocardial perfusion in hypertensive patients and the effect of blood pressure (BP) normalization is discussed. This review focuses on treatment strategies from a non-interventional and interventional perspective. Finally, current medications used in treating hypertension in ACS will be compared with regards to their mode of action and prognostic value.

Topics: Cardiovascular Agents; Disease Management; Humans; Hypertension; Myocardial Ischemia; Myocardial Revascularization

Aldosterone blockade is now seen as a crucial therapeutic strategy in the management of cardiovascular disease progression. There is increasing evidence that blocking the rennin-angiotensin-aldosterone system results in a reduction in overall cardiovascular risk. For 40 years, the only agent in this class was spironolactone. Despite its efficacy, the sexual side effects of spironolactone have resulted in poor compliance at best and discontinuation of therapy at worst. A newer agent, eplerenone, has been recently licensed for the treatment of heart failure and in the US also for hypertension. This article reviews the pathophysiology of aldosterone and critically reviews the present evidence for the efficacy and potential role for the new selective aldosterone-receptor antagonist, eplerenone.

Topics: Animals; Antihypertensive Agents; Cardiovascular Agents; Drug and Narcotic Control; Eplerenone; Heart Failure; Humans; Hypertension; Mineralocorticoid Receptor Antagonists; Renin-Angiotensin System; Spironolactone; Treatment Outcome

Cardiovascular disease (CVD) is the most common cause of death in women but some of the challenges of management differ from those in men. This article addresses the gender-specific issues of cardiovascular management, with emphasis on ischaemic heart disease and modification of coronary risk factors. Women with ischaemic heart disease present later than men, and are therefore older and more likely to suffer from co-morbidities such as diabetes and hypertension. Proven CVD risk factors in women can be divided into those that are modifiable and those that are non-modifiable. The former include diabetes, dyslipidaemia, hypertension, smoking, obesity, sedentary lifestyle and poor nutrition; the latter include family history of heart disease and older age at presentation. It is this difference in age and general health that explains much of the variability in response to treatment. Pharmacotherapy, percutaneous intervention, surgical revascularization, and cardiac rehabilitation and disease prevention are discussed.

Topics: Cardiac Catheterization; Cardiovascular Agents; Cardiovascular Diseases; Comorbidity; Coronary Artery Bypass; Dyslipidemias; Female; Health Knowledge, Attitudes, Practice; Humans; Hypertension; Life Style; Obesity; Postmenopause; Primary Prevention; Risk Factors; Sex Factors; Smoking; Stress, Psychological; United States; Women's Health

Recent trials of patients with cardiovascular disease (CVD) have provided a wealth of data regarding diagnosis, risk factors, and treatment. Aggressive risk factor management has been shown to improve patient survival, reduce recurrent events and the need for interventional procedures, and improve the quality of life in patients with known CVD. There have been impressive reductions in blood pressure and low-density lipoprotein cholesterol levels, and improved diabetes control. Medical therapy with options such as angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, and aspirin has been shown to have positive effects. Patients in current trials are more likely to be receiving appropriate treatment upon study entry than were patients in older trials. Changes in the risk profile of high-risk patients have reduced the overall rates of cardiovascular events and will continue to affect outcomes in randomized clinical trials. Such changes should be considered in the design of new clinical trials and in the interpretation of current data.

Topics: American Heart Association; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Anticholesteremic Agents; Antihypertensive Agents; Blood Pressure; Cardiovascular Agents; Cardiovascular Diseases; Cholesterol, LDL; Clinical Trials as Topic; Humans; Hypercholesterolemia; Hypertension; Models, Cardiovascular; Odds Ratio; Patient Selection; Platelet Aggregation Inhibitors; Practice Guidelines as Topic; Research Design; Risk Assessment; Risk Factors; United States

Topics: Cardiovascular Agents; Cardiovascular Diseases; Diabetes Complications; Humans; Hypercholesterolemia; Hypertension; Life Style; Male; Mental Health; Obesity; Risk Factors; Smoking; United States

Thirty-eight articles have been published on the association between elevated heart rate and mortality. After adjustment for other risk factors, most studies found an independent association between heart rate and all-cause and/or cardiovascular mortality. This relationship has been found to be generally weaker among females. The four studies performed in hypertensive patients found a positive association between heart rate and all-cause mortality or cardiovascular mortality. In spite of this evidence, elevated heart rate remains a neglected cardiovascular risk factor in both genders. The pathogenetic mechanisms connecting high heart rate, hypertension, atherosclerosis and cardiovascular events have also been elucidated in many studies. Several trials retrospectively showed the beneficial effect of cardiac-slowing drugs, such as beta-blockers and non-dihydropyridine calcium antagonists on mortality, notably in patients with coronary heart disease, or heart failure, but no published data are available in patients with hypertension free of coronary heart disease. Although it has not been proven in existing trials, it would seem reasonable to recommend in hypertensive subjects with heart rate > 80-85 b/min, antihypertensive agents that decrease the heart rate. The f-channel blockers, selective heart rate-lowering agents with no effect on blood pressure, could also be profitably used in hypertensive subjects with fast heart rate.

Topics: Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Antihypertensive Agents; Calcium Channel Blockers; Cardiovascular Agents; Clinical Trials as Topic; Coronary Artery Disease; Drug Therapy, Combination; Heart Diseases; Heart Rate; Humans; Hypertension; Risk Factors; Survival Rate; Tachycardia

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Biomarkers; Cardiovascular Agents; Clinical Trials as Topic; Coronary Disease; Defibrillators, Implantable; Diabetes Complications; Disease Progression; Female; Follow-Up Studies; Health Surveys; Heart Failure; Humans; Hypertension; Hypertrophy, Left Ventricular; Male; Mass Screening; Middle Aged; Multicenter Studies as Topic; Natriuretic Peptide, Brain; Pacemaker, Artificial; Practice Guidelines as Topic; Prevalence; Severity of Illness Index; Stroke Volume; Systole; Treatment Outcome; Ventricular Dysfunction, Left; Ventricular Remodeling

Cardiovascular disease continues to be a tremendous worldwide problem, and drug therapy is a major modality to attenuate its burden. At present, conditions such as hypertension, dyslipidaemia and heart failure are pharmacologically managed with an empirical trial-and-error approach. However, it has been suggested that this approach fails to adequately address the therapeutic needs of many patients, and pharmacogenetics has been offered as a tool to enhance patient-specific drug therapy. This review outlines pharmacogenetic studies of common cardiovascular drugs, such as diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statins and warfarin, ultimately highlighting considerations for future research and practice.

Topics: Anticoagulants; Cardiovascular Agents; Cardiovascular Diseases; Chronic Disease; Humans; Hypertension; Pharmacogenetics

Stroke is an important cause of morbidity and mortality, and is an economic burden. Diabetes and obesity are two important modifiable risk factors for stroke. Patients with diabetes have a higher incidence of stroke and a poorer prognosis after stroke. Risk-factor modification is the most important aspect of prevention of stroke in diabetes and obesity. This includes lifestyle modifications and different therapeutic modalities to control conditions, such as diabetes, hypertension, dyslipidemia and arrhythmia. Recent landmark studies have shown the beneficial effects of statins in diabetic patients even with close to normal or normal low-density lipoprotein cholesterol. Obesity, which is a risk factor for diabetes, hypertension and hyperlipidemia has been shown to be an independent risk factor for stroke. Increased leptin, dysregulation of adipocyte proteins, increased insulin resistance and C-reactive protein may be factors involved in the increased incidence of cardiovascular morbidity and mortality directly related to obesity. Visceral fat is a much bigger health risk than subcutaneous fat. Lifestyle interventions and pharmacotherapeutic agents have been used to manage obesity. In morbidly obese patients, surgical intervention seems to be the best method of treatment with a long-lasting favorable metabolic outcome. In the 21st Century, with the advanced medical knowledge and the therapeutic modalities available, it should be possible to reduce the incidence of stroke associated with diabetes and obesity.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Atrial Fibrillation; Blood Glucose; Cardiovascular Agents; Carotid Stenosis; Diabetes Mellitus; Diabetic Angiopathies; Diabetic Nephropathies; Diabetic Retinopathy; Dyslipidemias; Humans; Hypertension; Insulin Resistance; Ischemic Attack, Transient; Leptin; Life Style; Lipoproteins; Obesity; Plasminogen Activator Inhibitor 1; Risk Factors; Smoking; Stroke

The First Hungarian Therapeutic Consensus Conference took place on 3rd Nov. 2003 with the participation of 9 medical societies. Over the past 2 years the results of new major studies have been published and the American ATP III has also updated its guidelines issued in 2004. Based on the above proposals, the Second Hungarian Therapeutic Consensus Conference held on 3rd Nov. 2005 partly confirmed its earlier suggestions, but made some changes as well. Within the high risk category the Conference optionally created a very high risk group from those patients who - in addition to their cardiovascular disease--have either diabetes or metabolic syndrome or acut coronaria syndrome or who are chain smokers. We have included - as a complement - into the asymptomatic high risk category such newly emerging risk factors, one of which already in itself means high risk: ankle/arm index < or = 0.9, GFR <60 ml/min, microalbuminuria (30-300 mg), preclinical atherosclerosis (plaque). Besides, 4 other risk factors were also categorised such as Lp/a (> or = 30 mg/dl), CRP (> or = 3mg/l), homocysteine (> or = 12 micromol), familiarity--atherogenic gene constellation, but only the presence of at least two of these verify high risk. In very high risk group the goals of 3.5 mmol/l and 1.8 mmol/l were determined as therapeutic option. The goal in obese patients--expressed earlier only in BMI--can now be equally determined by the abdominal circumference (94 cm for men, 80 cm for women respectively). ACE inhibitors were recommended earlier as a preventive therapy in case of dysfunction of the left ventricle, while at present they are suggested for all patients with cardiovascular disease. In the recent recommendations guidelines related to nutrition, smoking, exercise have also been included.

Topics: Abdominal Fat; Acute Disease; Albuminuria; Atherosclerosis; Body Mass Index; Cardiovascular Agents; Cardiovascular Diseases; Consensus Development Conferences as Topic; Coronary Disease; Diabetes Complications; Dyslipidemias; Exercise; Feeding Behavior; Female; Humans; Hungary; Hypertension; Life Style; Male; Metabolic Syndrome; Obesity; Practice Guidelines as Topic; Risk Assessment; Risk Factors; Smoking Cessation; Societies, Medical; Therapeutics

Rho-kinase is a signaling molecule that occurs downstream of the small GTPase Rho, which mediates various cellular functions. The Rho/Rho-kinase pathway plays an important role in pathophysiology and progression of various cardiovascular diseases such as hypertension, coronary vasospasm, angina pectoris, and restenosis after percutaneous coronary intervention, all of which are related to arteriosclerosis/atherosclerosis changes of the vasculature. Activation of the Rho/Rho-kinase pathway contributes to inflammatory and proliferative changes of the blood vessels and affects cardiac myocytes. Evidence from in vitro and in vivo studies suggests that Rho-kinase inhibitors have beneficial effects on cardiovascular diseases, particularly arteriosclerosis and coronary vasospasm. Furthermore, activation of the Rho/Rho-kinase pathway contributes to blood pressure regulation via the central sympathetic nervous system. There is evidence to suggest that Rho-kinase is involved in angiotensin II-induced cardiac hypertrophy and endothelial dysfunction, and preliminary data indicate that inhibition of Rho-kinase may be beneficial in vascular disorders such as pulmonary arterial hypertension and erectile dysfunction. Fasudil is currently the only Rho-kinase inhibitor available for clinical use and it is approved in Japan for the prevention of vasospasm in patients with subarachnoid hemorrhage. Emerging clinical data have shown that oral fasudil 80 mg three times daily is effective in preventing myocardial ischemia in patients with stable angina pectoris. Rho-kinase represents a new target for the management of cardiovascular diseases and further studies are needed to define the therapeutic potential of Rho-kinase inhibitors.

Topics: Angina Pectoris; Brain; Cardiovascular Agents; Cardiovascular Diseases; Humans; Hypertension; Intracellular Signaling Peptides and Proteins; Protein Serine-Threonine Kinases; Randomized Controlled Trials as Topic; rho-Associated Kinases

Endothelin (ET) is among the strongest endogenous vasoconstrictors known and a potent mitogen. A rich body of experimental evidence suggests that ET contributes to vascular remodeling and end-organ damage in several cardiovascular conditions. Therefore, blockade of ET receptors has been suggested as an attractive target in a number of acute and chronic cardiovascular indications, including pulmonary arterial hypertension (PAH), systemic hypertension, and heart failure. To date, clinical studies have confirmed expectations in PAH and yielded promising initial results in systemic hypertension, which are currently awaiting confirmation in large-scale trials. In contrast, no added benefit could be demonstrated in large clinical trials on top of current standard treatment in both acute and chronic heart failure. Further clinical development in heart failure has therefore been suspended. Other indications that are currently being studied clinically or would possibly merit clinical trials include acute myocardial ischemia and reperfusion, cerebral vasospasm after intracranial bleeding, glaucoma, acute severe pancreatitis, systemic sclerosis, (diabetic) renal failure, restenosis after angioplasty/stent implantation, and late transplant rejection. This article critically reviews the available clinical data on ET receptor antagonism in cardiovascular indications against the background of the underlying preclinical research.

Topics: Animals; Cardiovascular Agents; Cardiovascular Diseases; Endothelin Receptor Antagonists; Heart Failure; Hemodynamics; Humans; Hypertension; Hypertension, Pulmonary; Ventricular Remodeling

Topics: Cardiovascular Agents; Cardiovascular Diseases; Diabetes Complications; Dyslipidemias; Female; Heart Failure; Humans; Hypertension; Risk Factors; Smoking; Women's Health

Optimal care of lupus nephritis patients should include the treatment of proteinuria and hypertension, other measures to delay the progression of chronic kidney disease, the vigorous management of cardiovascular risk factors and finally, the treatment of advanced chronic kidney disease and its consequences. These topics are briefly reviewed in the present paper, with particular emphasis on the recent progresses in antiproteinuric treatment.

Topics: Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Cardiovascular Agents; Cardiovascular Diseases; Disease Progression; Humans; Hypertension; Immunosuppressive Agents; Kidney Failure, Chronic; Lupus Nephritis; Patient Care; Proteinuria; Risk Factors

To review the antihypertensive, cardiovascular and pleiotropic effects of angiotensin-receptor blockers (ARBs).. ARBs are the most recently approved class of antihypertensive agents. They selectively block the angiotensin II type 1 receptor, thus inhibiting most of the deleterious effects of angiotensin II. In addition to blood-pressure control, other benefits may be gained using ARBs. This is because the renin-angiotensin system plays a crucial role in circulatory homoeostasis, and in patients with atherosclerosis, diabetes or hypertension, angiotensin II contributes to the pathophysiology of disease. Evidence-based medicine includes well-controlled studies with mortality and morbidity endpoints in patients with a variety of conditions including hypertension, type 2 diabetes, stroke, renal disease, heart failure, left-ventricular hypertrophy and coronary heart diseases. In addition to these hard endpoints, it has been shown that treatment with ARBs prevents the development of type 2 diabetes, ameliorates coronary and peripheral vascular endothelial dysfunction and decreases plasma levels of several markers of vascular inflammation.. ARBs are first-line agents for the treatment of hypertension and cardiovascular diseases. Blocking the renin-angiotensin system with these agents has special advantages due to specific vascular and antiatherosclerotic effects, which contribute to a better cardiovascular and renal protection in patients at risk from or with cardiovascular disease.

Topics: Angiotensin II Type 1 Receptor Blockers; Antihypertensive Agents; Cardiovascular Agents; Cardiovascular Diseases; Cerebrovascular Disorders; Coronary Disease; Diabetes Mellitus, Type 2; Endothelium, Vascular; Heart Failure; Humans; Hypertension; Hypertrophy, Left Ventricular; Kidney Diseases

The main goal of current antihypertensive therapy is to achieve a lowering of intra-arterial pressure by various mechanisms. A plethora of data suggests that this reduces cardiovascular morbidity and mortality due to stroke, heart failure and to a lesser extent, ischemic heart disease. Early cardiac manifestations of chronic hypertension, left ventricular hypertrophy (LVH) and diastolic dysfunction (CHF-D) confer additional risk of cardiovascular morbidity and mortality in patients with hypertension. Regression of left ventricular (LV) mass with antihypertensive therapy is associated with improved diastolic function and overall reduction in cardiovascular events, and this benefit may be independent of actual lowering of arterial pressure. Antihypertensive therapy should therefore be geared to both lower arterial blood pressure and specifically reverse pathophysiologic processes that promote LVH and CHF-D. Emerging therapies accomplish this without specifically affecting blood pressure. Therefore, future treatments for hypertension may require a combination of drugs performing complimentary tasks in lowering arterial pressure and reversing maladaptive physiologic and genetic processes causing hypertensive heart disease. This review summarizes the current and emerging approaches to the treatment of individuals with hypertensive heart disease.

Topics: Antihypertensive Agents; Cardiac Output, Low; Cardiovascular Agents; Heart Failure; Humans; Hypertension; Hypertrophy, Left Ventricular; Ventricular Dysfunction, Left

Omapatrilat is a dual angiotensin converting enzyme and neutral endopeptidase inhibitor. It is another a new class of drugs, which are effective in the treatment of patients with hypertension and heart failure also accompanying diabetes. They are producing difference endocrine changes, vasodilatation, diuresis, natriuresis and they have anti hypertrophic activity on tissues, reduce sympathetic tone. Omapatrilat produces beneficial effects in experimental animals and in clinical studies. The overall safety with omapatrilat appears to be good. Angioedema is a rare but potentially life threatening side-effects of endopeptidase inhibitors. Treatment with omapatrilat has a higher tendency towards preventing death and worsening heart failure.

Topics: Angiotensin-Converting Enzyme Inhibitors; Animals; Antihypertensive Agents; Cardiovascular Agents; Heart Failure; Humans; Hypertension; Pyridines; Thiazepines

The arachidonic cascade involves three types of metabolic pathways; cyclo-oxygenase, lipoxygenase(LO), and cytochrome P450. The products of LO pathway participate in the pathogenesis of variety of disease such as allergic diseases and hypertension. In particular, 12-hydroxyeicosatetraenoic acid(12-HETE); product of 12-LO pathway, is concerned in the development of hypertension induced by angiotensin-II. In fact, several investigators have reported that 12-HETE has a critical role in hypertension and LO inhibitors have antihypertensive effects in experimental animals. And so, we can expect organ-protective effects of LO inhibitors as well as antihypertensive effects. Besides 12-LO, several investigators mentioned that 5- and 15-LO also have influences to cardiovascular systems. Therefore, we can expect further elucidation of the mechanism of 12-LO's participation in the organ damage and the clinical roles of 12-LO inhibitors to prevent from organ failure in future.

Topics: Animals; Cardiovascular Agents; Hypertension; Lipoxygenase; Lipoxygenase Inhibitors; Umbelliferones

Topics: Cardiovascular Agents; Humans; Hypertension; Urotensins

Topics: Cardiovascular Agents; Cardiovascular Diseases; Comorbidity; Contraindications; Diet; Estrogen Replacement Therapy; Evidence-Based Medicine; Exercise; Expert Testimony; Female; Forecasting; Health Priorities; Humans; Hyperlipidemias; Hypertension; Life Style; Patient Education as Topic; Risk Factors; Smoking Cessation

Recent cross-sectional, population-based echocardiographic studies show that about half of all patients with heart failure have preserved left ventricular systolic function (HF-PSF). Cohort studies of hospitalized patients show a smaller proportion of HF-PSF. Compared to those with reduced systolic function, patients with HF-PSF are more often female, older, less likely to have coronary artery disease, and more likely to have hypertension. Patients with HF-PSF are less symptomatic and receive different pharmacologic therapy than patients with reduced systolic function. Morbidity and mortality rates in patients with HF-PSF are high but not quite as high as in patients with reduced systolic function. Though much has recently been learned about the syndrome of HF-PSF, many questions remain to be answered, not least how it should be treated.

Topics: Adult; Aged; Aged, 80 and over; Cardiovascular Agents; Comorbidity; Female; Heart Failure; Hospitalization; Humans; Hypertension; Male; Middle Aged; Myocardial Ischemia; Prognosis; Quality of Life; Ventricular Function, Left

Topics: Aged; Angiotensin II; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Animals; Cardiovascular Agents; Diabetic Nephropathies; Disease Models, Animal; Drug Synergism; Drug Therapy, Combination; Female; Heart Failure; Humans; Hypertension; Kidney Diseases; Male; Middle Aged; Myocardial Infarction; Proteinuria; Rats; Renin-Angiotensin System; Ventricular Dysfunction, Left

Topics: Alcohol Drinking; Antihypertensive Agents; Cardiovascular Agents; Comorbidity; Diabetes Mellitus; Diet, Reducing; Diet, Sodium-Restricted; Heart Failure; Humans; Hypertension; Kidney Diseases; Life Style; Motor Activity; Myocardial Ischemia; Obesity; Practice Guidelines as Topic; Weight Loss

Coronary artery disease is a major contributor to the progression of left ventricular systolic dysfunction and heart failure (HF). Recognizing that coronary artery disease is a leading cause of HF in the United States is critical to reducing mortality resulting from this condition. Although some patients may be candidates for mechanical revascularization to improve left ventricular function, all patients are candidates for aggressive secondary prevention strategies. This review discusses the prevalence of coronary artery disease, prognostic significance and pathophysiology, risk factor modifications, pharmacologic treatments, and the role of revascularization.

Topics: Age Distribution; Cardiovascular Agents; Chronic Disease; Coronary Artery Disease; Death, Sudden, Cardiac; Diabetes Complications; Disease Progression; Heart Failure; Humans; Hyperlipidemias; Hypertension; Morbidity; Myocardial Revascularization; Obesity; Practice Guidelines as Topic; Prevalence; Primary Prevention; Prognosis; Risk Factors; Risk Reduction Behavior; Smoking; United States; Ventricular Dysfunction, Left; Ventricular Remodeling

Diabetic cardiomyopathy is characterized by a prominent interstitial fibrosis. Postulated etiologies include microangiopathy, autonomic neuropathy, and metabolic factors. A common root of these pathologies is hyperglycemia or hyperinsulinemia, both of which are prominent in type 2 diabetes mellitus, which has the highest incidence of cardiovascular morbidity and mortality. The relative importance of each factor is a matter of debate; it is likely that both of these factors in addition to the concomitant risk factors seen in diabetics (dyslipidemias, hypertension, obesity, coagulation abnormalities) contribute to the spectrum of myocardial disease in diabetes. A discussion of these contributive pathologies and the hyperglycemia and hyperinsulinemia that underlie them is the subject of this review. Treatment methodologies to control the development of such pathology also are discussed.

Topics: Albuminuria; Blood Coagulation Disorders; Cardiovascular Agents; Cause of Death; Coronary Disease; Diabetes Mellitus, Type 2; Female; Global Health; Heart Failure; Humans; Hyperinsulinism; Hyperlipidemias; Hypertension; Hypoglycemic Agents; Incidence; Insulin Resistance; Male; Obesity; Oxidative Stress; Prognosis; Risk Factors; Sex Characteristics; United States

Women who experience heart failure (HF) exhibit distinct differences from men. Because women are a minority in major HF trials and because diagnostic criteria have been variable in epidemiologic surveys, many questions remain unanswered. This article describes differences in sex hormone effects and responses to injury, pressure overload, and aging, which may account for differences observed in epidemiology, risk factors and causes, mechanisms for disease development, response to treatment, and outcomes. Hypertension,diastolic dysfunction, diabetes, obesity, and inactivity are more important factors in women, whereas ischemic heart disease and systolic dysfunction are more important factors in men. Women appear to benefit less from established treatments but have better survival. Future studies directed exclusively at women may be warranted to confirm or establish benefits of existing and future treatments.

Topics: Adult; Age Distribution; Aged; Cardiovascular Agents; Cause of Death; Clinical Trials as Topic; Coronary Disease; Death, Sudden, Cardiac; Epidemiologic Studies; Female; Gonadal Steroid Hormones; Heart Failure; Humans; Hypertension; Middle Aged; Patient Selection; Prognosis; Risk Factors; Sex Characteristics; Sex Distribution; Sex Factors; Survival Rate; Treatment Outcome; United States; Women's Health

Topics: Aged; Cardiomegaly; Cardiovascular Agents; Echocardiography; Female; Heart Failure; Humans; Hypertension; Practice Guidelines as Topic; Stroke Volume; Ventricular Dysfunction

Topics: Cardiovascular Agents; Cardiovascular Diseases; Family Practice; Humans; Hyperlipidemias; Hypertension; Life Style; Metabolic Syndrome; Obesity; Risk Factors

The patient with chronic kidney disease and coronary artery disease (CAD) presents special challenges. This report reviews the scope of the challenge, the hostile internal milieu predisposing to CAD and cardiac events, management issues, unresolved dilemmas, and the need for randomized trials to allow for evidence-based treatment.

Topics: Angioplasty, Balloon, Coronary; Biomarkers; Cardiovascular Agents; Coronary Artery Bypass; Coronary Artery Disease; Creatinine; Diabetes Complications; Diagnosis, Differential; Drug Administration Schedule; Humans; Hyperhomocysteinemia; Hyperlipidemias; Hypertension; Inflammation; Kidney Failure, Chronic; Mass Screening; Oxidative Stress; Predictive Value of Tests; Prevalence; Reproducibility of Results; Risk Factors; Treatment Failure; United States

Vitamin D3 plays a key role in regulating calcium and mineral homeostasis in support of normal development and maintenance of bone. The classic effects of vitamin D3 include promoting absorption of dietary calcium in the gut and, through its actions as a steroid endocrine hormone, regulating the synthesis and secretion of parathyroid hormone. The effects of the vitamin D3 system are mediated through the highly regulated generation of the potent, active metabolite 1,25-dihydroxyvitamin D3 (calcitriol). Vitamin D3 exerts its effects through the vitamin D3 receptor (VDR), a ligand-activated nuclear receptor expressed in a wide array of tissue and cell types. Studies performed in mice rendered deficient for VDR suggest that calcitriol and VDR may inhibit the renin-angiotensin system and reduce blood pressure in the long-term. Clinical studies suggest that administration of vitamin D3 analogs produces differential benefit with regards to mortality in dialysis patients; other studies suggest that vitamin D3 analogs may provide cardiovascular benefit in both dialysis and nondialysis patients. This paper reviews clinical and preclinical studies, which suggest that vitamin D3 analogs may provide therapeutic utility in the treatment of cardiovascular disease independent of those mechanisms typically associated with the vitamin D3 endocrine system.

Topics: Animals; Cardiovascular Agents; Cardiovascular Diseases; Cholecalciferol; Clinical Trials as Topic; Heart Failure; Humans; Hypertension; Parathyroid Hormone

Heart failure is a common condition, associated with both poor prognosis and poor quality of life. In contrast to all other cardiovascular diseases, the prevalence of heart failure is increasing in the western world, and is likely to continue to do so as the population ages. In the UK, a significant proportion of patients with heart failure come from South Asian and African Caribbean ethnic groups. A large body of evidence exists that there may be epidemiological and pathophysiological differences between patients with heart failure from different ethnic groups. Treatments such as ACE inhibitors, which are now part of standard heart failure therapy, have an evidence base consisting of trials in patients of almost exclusively white ethnicity. Such treatments may not be equally effective in patients from other ethnic groups. This review will discuss the current evidence for heart failure management with respect to ethnicity, and consider the implications for future drug development and implications for antihypertensive therapy.

Topics: Cardiac Output, Low; Cardiovascular Agents; Drug Design; Humans; Hypertension

Advanced glycation end product (AGE) formation that occurs with aging and diabetes leads to the cross-linking of proteins and subsequent changes in the physicochemical properties of tissues. Cellular responses to AGE that lead to either pathological conditions or removal of AGE are mediated by a number of receptors that have been identified on various cell types such as macrophages, endothelial cells, and smooth-muscle cells. Mechanisms by which AGE affect the cardiovascular system include AGE cross-linking of long-lived proteins such as collagen and elastin and altered cellular responses. Alagebrium (3-phenacyl-4,5-dimethylthiazolium chloride, ALT-711) is the first drug in a new class of thiazolium therapeutic agents that break established AGE cross-links between proteins. In animal studies, alagebrium was effective in reducing large artery stiffness, slowing pulse-wave velocity, enhancing cardiac output, and improving left ventricular diastolic distensibility. In human studies to determine safety and efficacy, alagebrium was safe and well tolerated. In the first phase 2 clinical study, alagebrium improved arterial compliance in elderly patients with vascular stiffening. In two subsequent phase 2 clinical studies, one addressing diastolic heart failure and the other addressing systolic hypertension, alagebrium was effective in improving cardiac function and uncontrolled systolic blood pressure, particularly in more severely affected patients. Additional clinical studies to determine the utility of alagebrium in treating cardiovascular disorders associated with aging are in progress.

Topics: Aging; Animals; Blood Pressure; Blood Vessels; Cardiovascular Agents; Cardiovascular Diseases; Controlled Clinical Trials as Topic; Glycation End Products, Advanced; Heart Failure; Humans; Hypertension; Thiazoles

Investigation of arterial stiffness, especially of the large arteries, has gathered pace in recent years with the development of readily available noninvasive assessment techniques. These include the measurement of pulse wave velocity, the use of ultrasound to relate the change in diameter or area of an artery to distending pressure, and analysis of arterial waveforms obtained by applanation tonometry. Here, we describe each of these techniques and their limitations and discuss how the measured parameters relate to established cardiovascular risk factors and clinical outcome. We also consider which techniques might be most appropriate for wider clinical application. Finally, the effects of current and future cardiovascular drugs on arterial stiffness are also discussed, as is the relationship between arterial elasticity and endothelial function.

Topics: Arteries; Arteriosclerosis; Blood Pressure; Cardiovascular Agents; Diagnostic Techniques, Cardiovascular; Elasticity; Endothelium, Vascular; Forecasting; Humans; Hypertension; Magnetic Resonance Imaging; Predictive Value of Tests; Risk; Ultrasonography

Arterial stiffness is the most important cause of increasing systolic and pulse pressure, and for decreasing diastolic pressure with ageing. Many measures can be applied to quantify arterial stiffness, but all are approximations only, on account of the nonhomogenous structure of the arterial wall, its variability in different locations, at different levels of distending pressure, and with changes in smooth muscle tone. This article summarizes those indices with a focus on newer non-invasive methods and provides an overview of physiological, pathological and pharmacological influences on arterial hemodynamics. In the near future, the ability to detect and monitor subclinical arterial damage will improve cardiovascular risk stratification and act as a better guide in assessing the efficacy of therapeutic interventions than monitoring blood pressure alone. However, large-scale clinical trials are needed to prove the hypothesis that treatment of these new therapeutic targets will translate into clinical benefit, expressed in cardiovascular events or even mortality.

Topics: Age Factors; Arteries; Arteriosclerosis; Blood Flow Velocity; Cardiovascular Agents; Diabetes Complications; Exercise; Gender Identity; Heart Diseases; Hemodynamics; Humans; Hypertension; Pulsatile Flow

Management of hypertension has evolved steadily through 25 years of major clinical trials results modifying both the definition of hypertension and clinical management strategies. Trials experience in heart failure is much less extensive given the far smaller therapeutic market and traditionally often followed on the establishment of an agent or class of therapy in hypertension. Separate product profile development in heart failure is rare. Large outcome trials in heart failure are markedly smaller than those in hypertension and have tended to be confined to the last 15 years or so. There are clear examples of agents developed and successful in clinical use in both conditions but more recently the divergence of trials results in the two conditions has shown that comparable efficacy is no longer something which can be taken for granted. This review considers the past successes and more recent contrasts which have emerged in these traditional areas of pharmacological development.

Topics: Antihypertensive Agents; Cardiovascular Agents; Drug Design; Heart Failure; Humans; Hypertension

Stroke continues to have a devastating impact on public health. Recent epidemiological studies suggest that stroke is becoming more common, perhaps due to the ageing of the population and increased survival of patients with cardiac disease. There are specific and well-defined risk factors in patients with stroke, the most important being hypertension. Treatment options to reverse the effect of acute ischaemic stroke are limited. The only approved therapy is intravenous tissue plasminogen activator (tPA). The disadvantage of tPA treatment is a rate of symptomatic haemorrhage of about 6%. Newer stroke prevention options are currently being investigated including statins, oestrogen, angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). The challenge for physicians is to select the most effective intervention, and this depends on our knowledge of the underlying stroke mechanism and the patient's risk factors.

Topics: Aged; Aged, 80 and over; Angiotensin Receptor Antagonists; Brain Ischemia; Cardiovascular Agents; Female; Humans; Hypertension; Male; Middle Aged; Risk Factors; Stroke; United States

beta-Blocker therapy remains substantially underused in cardiac patients despite its proven mortality benefits. Reluctance to prescribe these agents may derive from concerns about their association with symptoms of depression, fatigue, and sexual dysfunction.. To determine the association of beta-blockers with depressive symptoms, fatigue, and sexual dysfunction by performing a quantitative review of randomized trials that tested beta-blockers in myocardial infarction, heart failure, and hypertension.. Randomized trials of beta-blockers used in the treatment of myocardial infarction, heart failure, or hypertension were identified by searching the MEDLINE database for English-language articles (1966-2001). In addition, we searched the reference lists of previously published trials and reviews of beta-blockers for additional studies.. Criteria for inclusion of trials in the review were: random allocation of study treatments, placebo control, noncrossover design, enrollment of at least 100 patients, and a minimum of 6 months of follow-up. The initial search produced 475 articles, 42 of which met these criteria. Fifteen of these trials reported on depressive symptoms, fatigue, or sexual dysfunction and were selected for inclusion.. For each trial, 1 author abstracted the frequency of adverse events in the beta-blocker and placebo groups and the numbers of patients randomized to the treatment groups. Two other authors verified the counts of events, and all authors adjudicated any discrepancies. Two different types of information on adverse events were abstracted: patient-reported symptoms and withdrawal of therapy due to a specified symptom. We categorized the tested beta-blockers by generation (early vs late) and lipid solubility (high vs low to moderate).. The 15 trials involved more than 35,000 subjects. beta-Blocker therapy was not associated with a significant absolute annual increase in risk of reported depressive symptoms (6 per 1000 patients; 95% confidence interval [CI], -7 to 19). beta-Blockers were associated with a small significant annual increase in risk of reported fatigue (18 per 1000 patients; 95% CI, 5-30), equivalent to 1 additional report of fatigue for every 57 patients treated per year with beta-blockers. beta-Blockers were also associated with a small, significant annual increase in risk of reported sexual dysfunction (5 per 1000 patients; 95% CI, 2-8), equivalent to one additional report for every 199 patients treated per year. None of the risks of adverse effects differed significantly by degree of beta-blocker lipid solubility. The risk associated with reported fatigue was significantly higher for early-generation than for late-generation beta-blockers (P =.04).. The conventional wisdom that beta-blocker therapy is associated with substantial risks of depressive symptoms, fatigue, and sexual dysfunction is not supported by data from clinical trials. There is no significant increased risk of depressive symptoms and only small increased risks of fatigue and sexual dysfunction. The risks of these adverse effects should be put in the context of the documented benefits of these medications.

Topics: Adrenergic beta-Antagonists; Cardiovascular Agents; Depression; Fatigue; Female; Heart Failure; Humans; Hypertension; Male; Myocardial Infarction; Randomized Controlled Trials as Topic; Risk; Sexual Dysfunction, Physiological

Thiazide diuretics, b-blockers, calcium channel blockers, and angiotensin converting enzyme (ACE) inhibitors are all superior to placebo for the primary prevention of coronary events in patients with hypertension. Recent studies have shown that ACE inhibitors are better than other antihypertensive agents in lowering overall cardiovascular morbidity and mortality, especially stroke. Blood pressure should be aggressively lowered (to < 140/90 mm Hg), especially in diabetic patients (to < 130/80 mm Hg), but care should be exercised in lowering the diastolic blood pressure below 65 mm Hg in patients with significant occlusive coronary artery disease. Hypertension in patients with stable angina should be treated with a b-blocker (alternatively a calcium channel blocker) together with an ACE inhibitor. Patients with hypertension and acute coronary syndrome (unstable angina or myocardial infarction) should be treated with a b-blocker, and with an ACE inhibitor if there is left ventricular dysfunction. A thiazide diuretic and/or a dihydropyridine calcium channel blocker could be added for blood pressure control. Calcium channel blockers should be avoided if there is significant left ventricular dysfunction.

Topics: Angina, Unstable; Blood Pressure; Cardiovascular Agents; Clinical Trials as Topic; Humans; Hypertension; Myocardial Infarction; Myocardial Ischemia

The prevalence of herb-drug interactions has been exaggerated. Nonetheless, some herbs, including garlic, ginkgo, ginseng, and St John's wort, can have a significant influence on concurrently administered drugs. Herbal medicines may mimic, decrease, or increase the action of prescribed drugs. This can be especially important for drugs with narrow therapeutic windows and in sensitive patient populations such as older adults, the chronically ill, and those with compromised immune systems.

Topics: Anticoagulants; Cardiovascular Agents; Digoxin; Drug Interactions; Herb-Drug Interactions; Humans; Hypericum; Hypertension; Hypokalemia; Phytotherapy; Plant Preparations

Topics: Antihypertensive Agents; Blood Pressure; Cardiovascular Agents; Diabetic Angiopathies; Humans; Hypertension; Pyridines; Renin-Angiotensin System; Thiazepines

Topics: Antihypertensive Agents; Blood Pressure; Cardiovascular Agents; Cardiovascular Diseases; Circadian Rhythm; Death, Sudden, Cardiac; Humans; Hypertension; Kidney Failure, Chronic; Myocardial Infarction

One of the aims of transplantation is to restore the potential for a full life to individuals with ESRD. To obtain this strategies that allow better and longer allograft function and a reduction in adverse events that lead to premature death are required. To this end, the recommendations below showed reduce cardiovascular disease and help present and future transplant recipients live a full life. Focusing on traditional risk factors (hypertension, hyperlipidemia, discontinuation of smoking, and prevention and treatment of diabetes mellitus) in patients at risk and striving for the recommended targets will have the greatest clinical benefit. These strategies should begin in the pre-dialysis and dialysis phases in order to reduce the cumulative burden of disease. Failing this, early and hopefully pre-emptive transplantation should be the goal.

Topics: Arteriosclerosis; Aspirin; Cardiovascular Agents; Cardiovascular Diseases; Comorbidity; Cost-Benefit Analysis; Diabetes Mellitus; Heart Function Tests; Humans; Hyperlipidemias; Hypertension; Hypertrophy, Left Ventricular; Hypoglycemic Agents; Hypolipidemic Agents; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Life Expectancy; Pancreas Transplantation; Postoperative Complications; Prevalence; Renal Dialysis; Risk Reduction Behavior; Smoking Cessation; Treatment Outcome

Topics: Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Cardiovascular Agents; Clinical Trials as Topic; Dose-Response Relationship, Drug; Humans; Hypertension; Neprilysin; Pyridines; Thiazepines

Topics: Cardiovascular Agents; Dentistry; Endocarditis, Bacterial; Heart Diseases; Humans; Hypertension; Mouth Diseases; Oral Hygiene

Carvedilol is a unique cardiovascular drug of multifaceted therapeutic potential. Its major molecular targets recognized to date are membrane adrenoceptors (beta 1, beta 2, and alpha 1), reactive oxygen species, and ion channels (K+ and Ca2+). Carvedilol provides prominent hemodynamic benefits mainly through a balanced adrenoceptor blockade, which causes a reduction in cardiac work in association with peripheral vasodilation. This drug assures remarkable cardiovascular protection through its antiproliferative/atherogenic, antiischemic, antihypertrophic, and antiarrhythmic actions. These actions are a consequence of its potent antioxidant effects, amelioration of glucose/lipid metabolism, modulation of neurohumoral factors, and modulation of cardiac electrophysiologic properties. The usefulness of carvedilol in the treatment of hypertension, ischemic heart disease, and congestive heart failure is based on a combination of hemodynamic benefits and cardiovascular protection.

Topics: Adrenergic alpha-Antagonists; Adrenergic beta-Antagonists; Animals; Antihypertensive Agents; Antioxidants; Blood Glucose; Carbazoles; Cardiovascular Agents; Cardiovascular System; Carvedilol; Heart Conduction System; Heart Failure; Humans; Hypertension; Lipids; Myocardial Ischemia; Neurotransmitter Agents; Propanolamines

Pregnant women with chronic hypertension are at risk for maternal and perinatal morbidity. Careful assessment and management of these patients during pregnancy are the keys to reducing maternal and fetal complications. Antihypertensive treatment should be used in women with high-risk chronic hypertension, whereas drug therapy does not improve pregnancy outcome in women at low risk. Prophylactic low-dose aspirin started early in pregnancy in women with chronic hypertension is not effective in reducing the frequency of superimposed preeclampsia and should be avoided.

Topics: Adult; Cardiovascular Agents; Chronic Disease; Female; Humans; Hypertension; Middle Aged; Postnatal Care; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular; Risk

The normal myocardium is composed of a variety of cells. Cardiac myocytes, tethered within an extracellular matrix of fibrillar collagen, represent one third of all cells; noncardiomyocytes account for the remaining two thirds. Ventricular hypertrophy involves myocyte growth. Hypertensive heart disease (HHD) includes myocyte and nonmyocyte growth that leads to an adverse structural remodeling of the intramural coronary vasculature and matrix. In HHD, it is not the quantity of myocardium but rather its quality that accounts for increased risk of adverse cardiovascular events. Structural homogeneity of cardiac tissue is governed by a balanced equilibrium existing between stimulator and inhibitor signals that regulate cell growth, apoptosis, phenotype, and matrix turnover. Stimulators (eg, angiotensin II, aldosterone, and endothelins) are normally counterbalanced by inhibitors (eg, bradykinin, NO, and prostaglandins) in a paradigm of reciprocal regulation. To reduce the risk of heart failure and sudden cardiac death that accompanies HHD, its adverse structural remodeling must be targeted for pharmacologic intervention. Cardioprotective agents counteract the imbalance between stimulators and inhibitors. They include ACE and endopeptidase inhibitors and respective receptor antagonists. Cardioreparative agents reverse the growth-promoting state and regress existing abnormalities in coronary vascular and matrix structure. ACE inhibition has achieved this outcome with favorable impact on vasomotor reactivity and tissue stiffness. Today's management of hypertension should not simply focus on a reduction in blood pressure, it must also target the adverse structural remodeling that begets HHD.

Topics: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Animals; Cardiovascular Agents; Endothelin Receptor Antagonists; Heart Diseases; Humans; Hypertension; Mineralocorticoid Receptor Antagonists; Receptor, Angiotensin, Type 1; Receptor, Angiotensin, Type 2

Topics: Antihypertensive Agents; Arterioles; Arteriosclerosis; Basement Membrane; Bone Remodeling; Calcinosis; Calcium; Cardiovascular Agents; Cardiovascular Diseases; Chronic Kidney Disease-Mineral and Bone Disorder; Diagnostic Tests, Routine; Disease Progression; Humans; Hyperparathyroidism; Hypertension; Hypertrophy, Left Ventricular; Kidney Transplantation; Osteoblasts; Renal Dialysis; Uremia; Vascular Diseases; Venules; Vitamin D

In the beagle dog, exaggerated hypotension and tachycardia following administration of high doses of vasodilating antihypertensive drugs are associated with vascular injury and characteristic patterns of myocardial necrosis and haemorrhage. Cardiac and vascular inflammation and necrosis also occur in dogs in association with different functional changes including severe hypertension and the effects that follow treatment with high doses of vasoconstrictor and pressor drugs. More recently, cardioactive drugs of novel classes such as the endothelin antagonists have also been shown to produce vascular damage in the beagle dog but in the absence of ischaemic myocardial damage or significant haemodynamic alterations that typically follow administration of high doses of vasodilating antihypertensive or pressor drugs. This underlines the importance of a careful analysis of the patterns of cardiovascular pathology, their dose, temporal and spatial relationships in the context of functional changes.

Topics: Animals; Arteritis; Cardiovascular Agents; Dogs; Endothelins; Humans; Hypertension; Hypotension; Muscle, Smooth, Vascular

Topics: Arteriosclerosis; Cardiovascular Agents; Cholesterol, LDL; Endothelins; Endothelium, Vascular; Humans; Hyperlipidemias; Hypertension

Hypertensive crisis is defined as an extreme elevation of arterial blood pressure, with diastolic pressure > 120 mm Hg, and represents an imminent risk to the patient. In such cases, a rapid orientating diagnosis and adequate antihypertensive treatment to avoid sequelae are needed, sometimes even before diagnostic tests are completed. Hypertensive emergencies and hypertensive urgencies can be distinguished. If the critical increase in blood pressure is associated with end-organ damage such as encephalopathy, acute left heart failure and pulmonary edema, angina pectoris, myocardial infarction or dissecting aortic aneurysm, a hypertensive emergency is present, that is an acute threat to the patient's life. A hypertensive emergency requires effective lowering of blood pressure within minutes, but not necessarily to normal range. The choice of suitable antihypertensive agents depends on clinical symptoms, contraindications, duration of pressure elevation and underlying conditions, prior cardiovascular, cerebrovascular and renal disorders. The risk of imminent end-organ damage must be weighed against the risk of rapid blood pressure lowering. In hypertensive urgencies without end-organ complications, blood pressure can be lowered more slowly over several hours, often with oral agents to avoid detrimental fall in blood pressure. The drugs of choice are mainly urapidil i.v. and nitroglycerine.

Topics: Cardiovascular Agents; Diagnosis, Differential; Dose-Response Relationship, Drug; Drug Administration Routes; Drug Therapy, Combination; Emergency Treatment; Humans; Hypertension; Hypertension, Malignant; Time Factors; Vasodilator Agents

The provision of dental treatment under both local anaesthesia and sedation has an excellent safety record, although medical problems may occur. The high prevalence of cardiac disease in the population, particularly ischaemic heart disease, makes it the most common medical problem encountered in dental practice. Additionally, the increasing survival of children with congenital heart disease makes them a significant proportion of those attending for dental treatment. While most dental practitioners feel confident in performing cardio-pulmonary resuscitation, treating patients with co-existent cardio-vascular disease often causes concern over potential problems during treatment. This article aims to allay many of these fears by describing the commoner cardiac conditions and how they may affect dental treatment. It outlines prophylactic and remediable measures that may be taken to enable safe delivery of dental care.

Topics: Anesthesia, Dental; Angina Pectoris; Anticoagulants; Arrhythmias, Cardiac; Cardiovascular Agents; Dental Anxiety; Dental Care for Chronically Ill; Drug Interactions; Emergency Treatment; Endocarditis, Bacterial; Heart Defects, Congenital; Heart Diseases; Heart Valve Diseases; Humans; Hypertension; Monitoring, Intraoperative

This paper provides current information on the pharmacologic management of cardiovascular diseases. It also describes the drugs used to treat five common cardiovascular disorders--heart failure, coronary artery disease, atrial fibrillation, hypertension, and unstable angina--and lists their dental implications. This information can be used to monitor patients for potential adverse drug reactions and drug interactions and to provide an information base for medical consultation.

Topics: Angina, Unstable; Atrial Fibrillation; Cardiovascular Agents; Coronary Disease; Dental Care for Chronically Ill; Heart Failure; Humans; Hypertension

Topics: Blood Pressure; Cardiovascular Agents; Chronobiology Phenomena; Chronotherapy; Heart Rate; Humans; Hypertension; Myocardial Ischemia; Treatment Outcome

Hypertension, a major risk factor for cardiovascular disease worldwide, remains inadequately diagnosed and treated, particularly in certain at-risk populations. Hypertension, often in association with other factors, increases the risk for the development of coronary artery disease (CAD). In turn, CAD increases the risk for related morbidity and mortality and presents treatment challenges. The chronobiology of many cardiovascular events offers a pathway for selecting optimal therapy for the hypertensive patient with CAD. Choosing a long-acting agent that achieves high plasma drug levels during critical hours may reduce the risk for cardiovascular morbidity and mortality.

Topics: Cardiovascular Agents; Chronotherapy; Circadian Rhythm; Coronary Disease; Hemodynamics; Humans; Hypertension; Risk Factors; Survival Rate

Biological functions and processes, including cardiovascular ones, exhibit significant circadian (24-hour) and other period rhythms. Ambulatory blood pressure assessment reveals marked circadian rhythms in blood pressure both in normotensive persons and hypertensive patients, whereas Holter monitoring substantiates day-night patterns in electrocardiographic events of patients with ischemic heart disease. The concept of homeostasis, that is, constancy of the milieu interne, which has dominated the teaching, research, and practice of medicine during the 20th century,is now being challenged by emerging concepts from the field of chronobiology-the science of biological rhythms. Epidemiologic studies document the heightened morning-time risk of angina, myocardial infarction, and stroke. Circadian rhythms in coronary tone and reactivity, plasma volume, blood pressure, heart rate, myocardial oxygen demand, blood coagulation, and neuroendocrine function plus day-night patterns in the nature and strength of environmental triggers all contribute to this morning vulnerability. Homeostatically devised pharmacotherapies, that is, medications formulated to ensure a near-constant drug concentration, may not be optimal to adequately control diseases that vary in risk and severity during the 24 hours. Moreover, circadian rhythms in the physiology of the gastrointestinal tract, vital organs, and body tissues may give rise to administration-time differences in the pharmacokinetics and effects of therapies. Thus the same medication consumed in the same dose under identical conditions in the evening and morning may not exhibit comparable pharmacokinetics and dynamics. New technology makes possible chronotherapy, that is, increase of the efficiency and safety of medications by proportioning their concentrations during the 24 hours in synchrony with biological rhythm determinants of disease. The chronotherapy of peptic ulcer disease achieved by the evening dosing of H 2-receptor antagonists and of asthma by the evening dosing of special drug delivery forms of theophylline and morning methylprednisolone administration has proven to be beneficial. Controlled-onset extended-release verapamil constitutes the first chronotherapy of essential hypertension and ischemic heart disease; once-a-day bedtime dosing results in a high drug concentration in the morning and afternoon and a reduced one overnight. Studies demonstrate effective 24-hour control of blood pressure, including the atte

Topics: Adrenergic beta-Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Calcium Channel Blockers; Cardiovascular Agents; Chemistry, Pharmaceutical; Chronotherapy; Coronary Disease; Humans; Hypertension; Nitroglycerin; Vasodilator Agents

Topics: Cardiovascular Agents; Diabetes Mellitus; Diet; Evidence-Based Medicine; Humans; Hyperlipidemias; Hypertension; Life Style; Myocardial Infarction; Recurrence; Risk Factors; Smoking Cessation

The sympathetic nervous system (SNS) plays an important role in the regulation of cardiac performance and peripheral circulation. Changes in SNS activity measured as catecholamines in plasma or organ spillover have been implicated in the pathogenesis of hypertension. Recent studies using microneurography to directly assess peripheral sympathetic nerve activity have demonstrated an increase in sympathetic activity in patients with borderline hypertension at rest and during hypoxia. We have recently shown that resting muscle sympathetic nerve activity is comparable in offspring of hypertensive and normotensive parents. However, during mental arithmetic the increase in muscle sympathetic nerve activity and blood pressure was significantly more pronounced in offspring of hypertensive than in offspring of normotensive parents, but resting blood pressure was in the normotensive range and comparable in both groups. These data indicate that the response to mental stress results in a more pronounced activation of SNS in normotensive subjects with a genetic background of hypertension. In other cardiovascular disease states such as acute myocardial infarction and heart failure activity of the SNS may determine prognosis significantly. Some calcium antagonists which are successfully used to treat patients with hypertension and stable angina pectoris may have unfavourable effects in patients with impaired left ventricular function. This could be due in part to baroreceptor-mediated activation of the SNS, an effect which seems to be related to pharmacokinetics and pharmacodynamics of the drugs. In contrast, angiotensin converting enzyme inhibitors seem to directly decrease sympathetic nerve activity. This may explain at least in part their beneficial effects in patients with impaired left ventricular function. Thus, the SNS as a regulator of the cardiovascular system also plays an important role in the pathophysiology of cardiovascular diseases such as hypertension, myocardial infarction and heart failure. Furthermore, drug therapy could have a significant impact on the activity of the SNS.

Topics: Arousal; Cardiovascular Agents; Catecholamines; Hemodynamics; Humans; Hypertension; Prognosis; Sympathetic Nervous System

Topics: Anemia; Cardiovascular Agents; Combined Modality Therapy; Drug Therapy, Combination; Humans; Hypertension; Hypertrophy, Left Ventricular; Kidney Failure, Chronic; Myocardial Ischemia; Renal Dialysis

Under the reference-based pricing (RBP) policy, British Columbia will fund drug therapies based on the cost of the 'gold standard' therapy that meets the needs of the majority of patients with a specific condition. Hence, Pharmacare will pay for the lowest cost drug within a cluster of related but different drugs, regardless of the indication. When evaluating the impact of drugs on health care expenditure, one must consider that their costs are more than offset by the clinical and economic benefits they provide. Pharmaceutical expenditure accounts for a small proportion of health care expenditure and should be viewed as an essential and interactive component in the global health care budget rather than as an independent constituent. In that respect, insight should be gained from many countries in which RBP has been implemented A wealth of data converge to the same conclusion: price controls and restricted access to drugs do not reduce prescription drug expenditures but actually increase health care costs. Furthermore, cost containment being the main issue behind RBP in British Columbia, the contentious issue of therapeutic substitution has not been taken fully into consideration, nor has its impact on the quality of care of the patient. The case of diltiazem once-a-day versus diltiazem tablets for hypertensive and angina patients illustrates the important considerations that must be taken into account in writing the overall financial equation that drives the implementation of the RBP policy. If pharmacotherapy is to be an appropriate treatment to attain optimal cost effective health care, its benefit can only be optimized with a strategy that entails the right therapy, for the right patient, in the right dosage form and at the right time. Accordingly, RBP in British Columbia should be analyzed in light of patient welfare and appropriate use of collective resources.

Topics: Angina Pectoris; Antihypertensive Agents; British Columbia; Cardiovascular Agents; Cost Control; Diltiazem; Drug Administration Schedule; Drug Costs; Drugs, Generic; Humans; Hypertension; Patient Compliance; Prescription Fees; Quality of Health Care

Current management of patients after an acute myocardial infarction (AMI) reflects a variety of approaches ranging from conservative to aggressive. Although each method is appropriate in certain subgroups, their application frequently lacks a scientific basis. Current, clinically relevant, evidence-based practice guidelines are needed for secondary prevention for survivors after an AMI. To meet this need, the California Cardiology Working Group was assembled to evaluate the available data from clinical trials and other published studies and develop evidence-based, cost-effective guidelines for clinicians to use as a basis for patient management after an AMI. The group consisted of 18 members, including cardiologists from academic institutions and physicians working in cardiac intensive care, private practices, and managed care settings, representing a broad spectrum of expertise pertaining to patients who have had an AMI. The members had expertise in cardiac intensive care, interventional cardiology, nuclear cardiology, lipid disorders, echocardiography, and cardiac rehabilitation. The intended audience for these practice guidelines includes all physicians who treat survivors of MI. A literature review of all relevant clinical trials and other published data about the natural history after AMI and the effects of current therapeutic modalities are discussed herein. Case histories served as models for application of the literature-based data. The recommendations for management were reached by consensus vote based on the scientific evidence. When more than 1 management option applied, this was recognized in the recommendations. The recommendations accompany the text.

Topics: Arrhythmias, Cardiac; Cardiovascular Agents; Cost-Benefit Analysis; Evidence-Based Medicine; Exercise; Humans; Hyperlipidemias; Hypertension; Myocardial Infarction; Myocardial Ischemia; Prognosis; Risk; Risk Factors; Smoking; Ventricular Function, Left

Patients with cardiovascular disease can derive significant benefit from the implementation of risk reduction therapies. Until recently, management of patients with coronary heart disease has centered on the use of angioplasty, bypass surgery and medical therapy for severe fixed obstructions. Several large randomized clinical trials now demonstrate the importance of medical risk reduction therapies in these patients. A consensus panel of the American Heart Association recommends that health care providers use a group of risk reduction therapies, which can significantly extend overall survival, improve quality of life, decrease the need for interventional procedures such as angioplasty and bypass grafting, and reduce the incidence of subsequent myocardial infarction. Since a minority of patients with cardiovascular disease now benefit from these strategies, changes in our health care delivery systems are recommended. Risk reduction case management by nursing staff can assist physicians and improve implementation of and patient adherence to these therapies. Programs are being discussed to develop support by third-party insurers for risk reduction therapies. Application of these therapies should be a routine part of care for patients with cardiovascular disease.

Topics: American Heart Association; Cardiovascular Agents; Case Management; Coronary Disease; Exercise; Humans; Hyperlipidemias; Hypertension; Myocardial Infarction; Nurses; Quality of Life; Randomized Controlled Trials as Topic; Risk; Risk Factors; Smoking; Smoking Cessation; Survival Rate; United States; Weight Loss

The sympathetic nervous system is an important regulator of the circulation. Interactions with other regulating systems, e.g. the renin angiotensin system, play important roles. By means of microneurography, sympathetic activity in humans can be assessed directly in the nerve. Insights into the dynamic regulation of the circulation under physiological and pathophysiological conditions are possible. Activation of the sympathetic nervous system in cardiovascular diseases affects course, prognosis, and therapy. Prognosis in heart failure depends on sympathetic activation, which can be decreased by inhibition of angiotensin II synthesis by ACE-inhibitors. In contrast to nitrates, these drugs do not increase sympathetic activity. The sympathetic nervous system is also heavily involved in the pathogenesis of hypertension. Borderline hypertensives and offspring of hypertensive parents show increased sympathetic nerve activities. Investigation of the sympathetic nervous system under physiological and pathophysiological conditions may serve as a basis for new therapeutic strategies.

Topics: Cardiovascular Agents; Cardiovascular System; Heart Failure; Humans; Hypertension; Sympathetic Nervous System

To help resolve abnormalities in cardiovascular function, many different types of drugs have been developed. Only recently, however, has there been increased emphasis on determining flow these agents decrease morbidity and mortality. In some cases, standard drug therapy has been challenged somewhat by newer drugs or new applications of existing drugs that seem to provide better outcomes in terms of disease progression and survival. The purpose of this article is to provide an update on contemporary pharmacologic management of three common conditions: hypertension, congestive heart failure, and myocardial ischemia/infarction. Physical therapists should be aware of the rationale for using specific drugs in each condition and that these medications can have positive therapeutic effects and adverse side effects that can influence the patient's response to physical therapy.

Topics: Cardiovascular Agents; Heart Failure; Humans; Hypertension; Morbidity; Myocardial Ischemia; Physical Therapy Modalities; Survival Rate; Treatment Outcome

Elderly patients have a significantly higher mortality and morbidity compared with younger patients in the postmyocardial infarction period and thus, with the appropriate management have a greater potential for benefit compared with younger patients. It has been shown in the large randomized trials that elderly patients with acute myocardial infarction benefit significantly from administration of beta-blocking agents and angiotensin-converting enzyme inhibitors. Aspirin and warfarin sodium (Coumadin) have been shown to benefit patients of all age groups. Secondary prevention with cessation of smoking, use of lipid-lowering agents, treatment of hypertension, and estrogen therapy in the postmenopausal woman have been shown to be effective. Elderly patients, therefore, who are free of general noncardiac disability and who can be expected to live meaningful lives should be offered a comprehensive program to reduce their cardiac morbidity and mortality after discharge following acute myocardial infarction.

Topics: Adrenergic beta-Antagonists; Aged; Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Arrhythmias, Cardiac; Aspirin; Calcium Channel Blockers; Cardiovascular Agents; Estrogens; Female; Humans; Hyperlipidemias; Hypertension; Male; Myocardial Infarction; Risk Factors; Smoking

Topics: Animals; Atrial Natriuretic Factor; Blood Pressure; Cardiovascular Agents; Humans; Hypertension; Natriuretic Peptide, C-Type

The incidence and prevalence of congestive heart failure increase exponentially with advancing age. Congestive heart failure in the elderly is characterized by a multifactorial etiology, a high proportion of accompanying degenerative changes of the cardiovascular system and age-specific problems regarding diagnosis and treatment. The treatment strategy is the same as in younger patients, but the higher incidence of adverse effects and complications demands special awareness. The majority of decompensations leading to hospitalization are precipitated by insufficient compliance in life style change and drug intake.

Topics: Adult; Aged; Aging; Arrhythmias, Cardiac; Arteriosclerosis; Cardiomyopathies; Cardiovascular Agents; Coronary Disease; Heart Failure; Humans; Hypertension; Incidence; Middle Aged; Prevalence

Physiological functions as well as pathophysiological events--angina pectoris, myocardial infarction, sudden cardiac death--display pronounced circadian rhythms. Clinical studies also give evidence for a circadian phase dependency in the pharmacokinetics of cardio-vascular active drugs. Thus, a circadian phase dependency in the dose-response relationship of drugs has to be taken into account.

Topics: Animals; Biological Availability; Biological Clocks; Cardiovascular Agents; Cardiovascular Diseases; Cardiovascular System; Circadian Rhythm; Dose-Response Relationship, Drug; Drug Administration Schedule; Hemodynamics; Humans; Hypertension; Rats

Topics: Cardiotonic Agents; Cardiovascular Agents; Cardiovascular Diseases; Clinical Trials as Topic; Cost-Benefit Analysis; Fibrinolytic Agents; Heart Failure; Humans; Hypertension; Hypertrophy, Left Ventricular; Sociology

With rapidly progressing therapeutic methods in the cardiovascular medicine, scientific evaluations for newly developed cardiovascular drugs and therapies have become mandatory. We have launched five large scale multicenter cooperative studies, namely, Japan Multicenter Investigation for Cardiovascular Drugs/Therapies, J-MIC (I), (B), (M), (S), and (K). The aims of studies include to investigate: the best therapeutic approach in patients with acute myocardial infarction who underwent thrombolytic therapy with or without any adjunctive treatment (I), the long-term comparative study (3 years) of nifedipine (extended release tablet) with ACE inhibitor in patients with essential hypertension and ischemic heart disease (B), the long-term effect (3 years) of trapidil and/or ethyl icosapentate in patients with ischemic heart disease with or without arteriosclerotic obstructive disease in terms of progression or regression of atherosclerotic changes in coronary as well as peripheral arteries (M), the efficacy and safety of pravastatin to prevent post-PTCA restenosis (S), and regression of atherosclerotic lesion of coronary arteries in patients with familial hypercholesterolemia by LDL apheresis (K).

Topics: Cardiovascular Agents; Clinical Protocols; Coronary Artery Disease; Coronary Disease; Female; Heart Diseases; Humans; Hypertension; Japan; Male; Multicenter Studies as Topic

Indicators such as lowering of blood pressure in hypertension, alleviation of chest pain in angina pectoris, improvement in rest or exertional dyspnea from congestive heart failure (CHF) and suppression of ventricular arrhythmia are widely used in the management of cardiovascular diseases. There are often strong associations between the physiological indicators and the long-term clinical outcomes of cardiovascular disease such as stroke, myocardial infarction, sudden death and all-cause mortality. Physicians have assumed reasonably that early improvements in physiological markers will lead invariably to better long-term clinical outcomes. In recent years, a number of large clinical trials have demonstrated that short-term physiological improvements are not necessarily linked to better long-term clinical outcomes, but may be associated with less benefit than expected or even with detrimental outcomes. Management of cardiovascular diseases is complicated by the possibility that beneficial effects of a particular drug may be offset by its negative actions on the cardiovascular system. Effective antihypertensives may depress cardiac contractility; inotropes enhance left ventricular contractility in CHF, but may increase the risk of serious ventricular dysrhythmia; drugs which suppress ventricular arrhythmia may precipitate CHF or even excite pro-arrhythmic effects. Physicians must be conscious of this interplay of potentially beneficial and deleterious effects when cardiovascular drugs are prescribed. It is important in the analysis of large clinical trials of cardiovascular drugs to identify those situations in which the drug exhibits more benefit than harm and to determine, if possible, those aspects of drug action, drug dosage and population characteristics which contribute to the beneficial and detrimental actions.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Angiotensin-Converting Enzyme Inhibitors; Arrhythmias, Cardiac; Cardiovascular Agents; Cardiovascular Diseases; Heart Failure; Humans; Hypertension; Myocardial Ischemia; Treatment Outcome

Topics: Angiotensin-Converting Enzyme Inhibitors; Cardiovascular Agents; Digitalis Glycosides; Diuretics; Heart Failure; Humans; Hypertension; Myocardial Infarction; Prognosis

Angiotensin converting enzyme (ACE) inhibitors which have active moieties excreted mainly in urine require adjustment of either the dose or the interval between doses in patients with moderate to severe renal dysfunction or severe congestive heart failure. Those agents such as temocapril (CS 622) and fosinopril, excreted both in urine and bile, may not require such adjustment. Renal clearance of ACE inhibitors may be reduced and some accumulation may occur in elderly patients with mild renal dysfunction or congestive heart failure. The bioavailability of ACE inhibitors is reduced by concomitant food or antacids which may slow gastric emptying and raise gastric pH. Pharmacokinetic interactions with ACE inhibitors are unlikely in patients receiving thiazide or loop diuretics. When ACE inhibitors are given hyperkalaemia may occur in patients with renal insufficiency, those taking potassium supplements or potassium-sparing diuretics, and in diabetic patients with mild renal impairment. While no pharmacokinetic interaction precludes use of this combination, the pharmacokinetics of some ACE inhibitors are subject to greater variability when patients also receive beta-blockers. Calcium antagonists and ACE inhibitors have additive anti-hypertensive effects and pharmacokinetic interactions between these agents are unlikely. One report exists of a significant effect of coadministered hydralazine on the pharmacokinetics and urinary excretion of lisinopril. Data on interactions between ACE inhibitors and digitalis are contradictory. There is no evidence that the concomitant use of ACE inhibitors and digoxin is associated with an increased risk of digitalis toxicity. ACE inhibitors are mainly excreted by glomerular filtration and renal tubular secretion. Possible interactions between ACE inhibitors and probenecid have been noted, with renal and total body clearance of ACE inhibitors being potentially reduced in the presence of probenecid. Probenecid pretreatment may enhance the pharmacodynamic response of ACE inhibitors. Few but contradictory data exist on the effects of H2-blockers on ACE inhibitor pharmacokinetics and little information is available on interactions between ACE inhibitors and hypoglycaemic drugs. Some case reports link ACE inhibitors with the induction of lithium toxicity. Coadministration of lithium should be undertaken with caution, and frequent monitoring of lithium concentrations is recommended with all ACE inhibitors. Nonsteroidal anti-inflammat

Topics: Angiotensin-Converting Enzyme Inhibitors; Anti-Inflammatory Agents, Non-Steroidal; Cardiovascular Agents; Dose-Response Relationship, Drug; Drug Interactions; Half-Life; Heart Failure; Humans; Hypertension

The nutrients to the different organs of the body are provided through the blood supply to these organs. Since the nutrient requirements change considerably and abruptly according to the demands set by, for example, physical activity, organ blood flow has to be adjusted accordingly. This is achieved by a complex interplay between neural (parasympathetic and sympathetic nerves), humoral (vasopressin, angiotensin, etc.), and local (ions, pH, adenosine, etc.) factors. It is also well recognized that diseases, such as hypertension and heart failure, as well as the drugs to treat them, can substantially affect organ blood flow. Using tracer microspheres, several studies in animals have shown that, during the established phase of hypertension, there is some decrease in cardiac output, which is then redistributed, with the brain, small intestines, and heart receiving a higher proportion. Blood flow to and vascular conductance in the other organs, particularly the kidneys, is decreased. Similar findings have also been observed in human hypertension. During congestive heart failure, most organs show a decrease in blood flow and there is a conspicuous increase in the sympathetic nerve activity. The drug responses may differ in the disease state and, from a clinical viewpoint, changes in some circulatory beds (e.g., cerebral, cardiac, renal, skeletal muscles) as well as the partition of blood flow into nutrient (tissue) and non-nutrient (arteriovenous anastomoses or shunts) parts can be of great importance. For example, overzealous antihypertensive therapy or the use of cerebral vasodilators may adversely affect cerebral circulation in certain situations and increased arterial blood flow may only be in the arteriovenous anastomotic part of the circulation.

Topics: Animals; Cardiovascular Agents; Heart Failure; Humans; Hypertension; Regional Blood Flow

About 10% of survivors of an acute myocardial infarction will die in the following year. Thereafter the risk declines but reinfarction is still an important cause of mortality and morbidity. The post infarction trials have clearly shown that the best proven agents to mitigate this toll are aspirin, beta adrenoceptor blockers, and verapamil (but not other calcium blockers, except diltiazem for non Q wave infarction). In the context of hypertension treatment these post infarction trials may have important lessons for drug selection and ancillary treatment since the majority of subjects will ultimately die of ischaemic heart disease. Although the newer agents such as ACE and renin inhibitors, newer calcium channel blockers and alpha blockers have many promising properties in terms of risk factor reduction, no convincing mortality data exists; it is needed. This review will deal with the known effects (both good and bad) of antihypertensive agents and will also review other drug strategies relevant to the hypertensive patient. It will also point out large areas of ignorance.

Topics: Adrenergic beta-Antagonists; Antihypertensive Agents; Aspirin; Cardiovascular Agents; Humans; Hypertension; Myocardial Infarction; Recurrence

The guidelines for medical treatment of Takayasu arteritis established in 1987 by the Systemic Vascular Disorders Research Committee, Ministry of Health and Welfare of Japan are presented. The first part of the guidelines concerns treatment with adrenocorticosteroids and the second part concerns other medical treatment. A review of the literature referring to steroid therapy and other medical treatment of Takayasu arteritis is also included.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Antihypertensive Agents; Cardiovascular Agents; Humans; Hypertension; Immunosuppressive Agents; Prednisolone; Takayasu Arteritis

The pharmacologic approach to coronary protection, defined here as the prevention or delay of sudden death and myocardial infarction (without negatively affecting noncardiac mortality), is critically discussed. The value of pharmacologically treating mild hypertension and mild hypercholesterolemia is questioned, and the need for well-designed, randomized clinical trials with definitive endpoints to determine a drug's cardioprotective capability is emphasized. Based on such studies, it is concluded that some (but perhaps not all) beta-receptor antagonists as well as aspirin have been shown to protect against sudden cardiac death. Trials of thiazide diuretics, calcium antagonists, and angiotensin-converting enzyme inhibitors have not shown a reduction in sudden cardiac death, despite having individual benefits with respect to other aspects of cardiovascular disease. The demonstration that some beta blockers are cardioprotective is discussed in terms of the pathophysiology of sudden cardiac death, and differences in the pharmacokinetic profiles of individual agents.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Animals; Calcium Channel Blockers; Cardiovascular Agents; Death, Sudden, Cardiac; Europe; Humans; Hypercholesterolemia; Hypertension; Myocardial Infarction

Sufficient evidence exists to implicate hypertension as a potent independent risk factor for the development of atherosclerosis. Whereas certain biochemical pathways may play some role in the genesis of atherosclerosis in patients with hypertension, the blood pressure level alone may accelerate the atherosclerotic process. This article discusses the link between hypertension, atherosclerosis, and antihypertensive therapy.

Topics: Antihypertensive Agents; Arteriosclerosis; Cardiovascular Agents; Clinical Trials as Topic; Disease Models, Animal; Hemodynamics; Humans; Hypertension

To properly predict drug effects in elderly patients for cardiovascular drugs requires understanding of age-related and disease-related changes in tissues and organs which mediate the observed pharmacodynamic response. Linking this understanding with the known changes in drug pharmacokinetics permits more effective cardiovascular pharmacotherapy in the geriatric patient. At the present time only a limited number of drug classes have been studied in this manner. Although it may be intuitively obvious that human pathophysiology may impact on drug response, until recently we have relied solely on description of drug concentration or pharmacokinetics to predict expected responses. We can look forward to improved geriatric therapeutics when the patient as well as the drug is considered as a variable in clinical therapeutic responses.

Topics: Aged; Aging; Cardiovascular Agents; Cardiovascular System; Dose-Response Relationship, Drug; Humans; Hypertension; Pharmacology, Clinical

Like all other scientific disciplines, preclinical pharmacological research is subject to permanent changes. New measuring devices and the possibility of continuous on line data acquisition have markedly influenced basic research in this field. Another aim of modern cardiovascular pharmacology is the testing of promising drugs in clinically relevant animal models of disease, particularly under conditions, referring to the everyday situation in patients, e.g. physical activity. Investigations carried out in this way allow an exact assessment of the clinical efficacy of new drugs, and are, thus, clearly indispensable, also from the ethical point of view, before primary evaluation of the drug in man.

Topics: Angina Pectoris; Animals; Arrhythmias, Cardiac; Austria; Cardiovascular Agents; Cats; Dogs; Drug Evaluation, Preclinical; Electric Countershock; Humans; Hypertension; Myocardial Infarction; Pharmacology; Rats; Research

Dietary magnesium (Mg) deficiency is more prevalent than generally suspected and can cause cardiovascular lesions leading to disease at all stages of life. The average American diet is deficient in Mg, especially in the young, in alcoholic persons, and in those under stress or with diseases or receiving certain drug therapies, who have increased Mg needs. Otherwise normal, Mg-deficient diets cause arterial and myocardial lesions in all animals studied, and diets that are atherogenic, thrombogenic and cardiovasopathic, as well as Mg-deficient, intensify the cardiovascular lesions, whereas Mg supplementation prevents them. Diuretics and digitalis can intensify an underlying Mg deficiency, leading to cardiac arrhythmias that are refractory unless Mg is added to the regimen. Potassium (K) depletion in diuretic-treated hypertensive patients has been linked to an increased incidence of ventricular ectopy and sudden death. K supplementation alone is not the answer. Mg has been found to be necessary to intracellular K repletion in these patients. Because patients with congestive heart failure and others receiving diuretic therapy are also prone to chloride loss leading to metabolic alkalosis that also interferes with K repletion, the addition of Mg and chloride supplements in addition to the K seems prudent.

Topics: Cardiovascular Agents; Cardiovascular Diseases; Chlorides; Diet; Female; Heart Diseases; Humans; Hypertension; Magnesium; Magnesium Deficiency; Potassium; Pregnancy; Stress, Physiological

Topics: Adrenergic alpha-Agonists; Adrenergic beta-Antagonists; Angina Pectoris; Arrhythmias, Cardiac; Calcium Channel Blockers; Cardiovascular Agents; Digitalis; Diuretics; Hemodynamics; Humans; Hypertension; Isometric Contraction; Nitroglycerin; Physical Exertion; Plants, Medicinal; Plants, Toxic

An appreciation of the hemodynamic and biochemical changes induced by drugs is critical for a logical diagnostic interpretation of graded stress tests and the evaluation of the projected exercise prescription and exercise programs that a patient is asked to follow. Drug therapy is clearly not a contraindication to acute or chronic exercise as long as the potential benefits and complications of exercise and drug interaction are considered.

Topics: Angina Pectoris; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Cardiovascular Agents; Coronary Disease; Heart Failure; Humans; Hypertension; Physical Exertion

Topics: Adrenergic beta-Antagonists; Age Factors; Angioplasty, Balloon; Anti-Arrhythmia Agents; Anticoagulants; Cardiovascular Agents; Coronary Artery Bypass; Diabetes Mellitus; Humans; Hypercholesterolemia; Hyperlipoproteinemias; Hypertension; Myocardial Infarction; Physical Exertion; Platelet Aggregation; Risk; Smoking Prevention

Acute, severe increases in arterial blood pressure cause sustained cerebral arteriolar dilation, abnormal reactivity to carbon dioxide and to changes in blood pressure, abolition of endothelium-dependent dilation from acetylcholine, discrete morphological lesions of the endothelium and vascular smooth muscle, and breakdown of the blood-brain barrier to plasma proteins. The dilation, abnormal reactivity, and morphological abnormalities are inhibited by pretreatment with cyclooxygenase inhibitors or with free radical scavengers. Superoxide dismutase-inhibitable reduction of nitroblue tetrazolium applied to the brain surface was detectable both during hypertension and one hour after hypertension subsided. Nitroblue tetrazolium reduction is also reduced by inhibitors of the anion channel. The abnormalities seen after hypertension are reproduced by topical application of arachidonate. The results are consistent with the view that acute hypertension induces generation of superoxide anion radical in association with accelerated arachidonate metabolism via cyclooxygenase. This radical enters cerebral extracellular space via the anion channel and gives rise to hydrogen peroxide and hydroxyl radical. All three radicals are capable of causing vasodilation by relaxation of cerebral vascular smooth muscle. The hydroxyl radical is the most likely candidate for vascular wall damage. The significance of this mechanism in chronic experimental hypertension or its relevance to human disease is not known.

Topics: Animals; Arachidonic Acid; Arachidonic Acids; Arterioles; Blood Proteins; Blood-Brain Barrier; Bradykinin; Brain; Brain Injuries; Cardiovascular Agents; Catalase; Cerebrovascular Circulation; Cerebrovascular Disorders; Cyclooxygenase Inhibitors; Endothelium; Free Radicals; Hydrogen Peroxide; Hydroxides; Hydroxyl Radical; Hypertension; Leukocytes; Leukotrienes; Lipid Peroxides; Muscle, Smooth, Vascular; Peroxidases; Prostaglandin-Endoperoxide Synthases; Prostaglandins G; Superoxide Dismutase; Superoxides; Vasodilation; Xanthine Oxidase

Diuretics are the mainstay of drug therapy in the treatment of many cardiovascular disorders. However, perusal of knowledge of their haemodynamic activities in heart failure and hypertension reveals major gaps. In left ventricular failure complicating acute myocardial infarction, intravenous frusemide reduces the elevated left heart filling pressure with little change in systemic blood pressure, heart rate or cardiac output, and restores the ability of the left heart to handle an acute increase in filling volume. But there is little knowledge of the haemodynamic effects of other intravenous diuretics, oral diuretics or diuretics other than those acting on the loop of Henle in this emergency clinical situation. Even less information is available on the haemodynamic effects of diuretics in patients in chronic heart failure. In patients with valvular heart disease, parenteral mercury and oral thiazides reduce right heart and pulmonary vascular pressures with variable (dose-dependent?) changes in cardiac output. Information on the effect of loop diuretics, the comparative effects of intravenous versus oral routes of administration and dose-response correlations are all lacking. In hypertension, the dose-blood pressure lowering response relationship of orally administered diuretics is relatively flat. The majority of information relates to oral thiazides; there is little reliable information on the anti-hypertensive efficacy of the loop diuretics. The acute and chronic effects of the majority of commonly used diuretics on cardiac and peripheral vascular functions is unexplained. More is known of their potentially adverse metabolic effects than of their possible circulatory benefits in hypertensive patients. Many unwanted side-effects of these drugs have been described; their potential importance is related directly to the disease state and doses in which they are used. In acute heart failure, their potential danger is probably minimal. In the treatment of chronic heart failure their most sinister potential is in the excessive secretion of potassium and magnesium. In hypertensive patients their long-term administration in high-doses may lead to undesirable metabolic effects that tend to offset their blood pressure lowering activity. Despite their drawbacks, diuretics continue to provide the natural first-line treatment of choice of these common cardiovascular syndromes. But more information on their mechanisms of vascular activities and the differences in non-d

Topics: Angina Pectoris; Antihypertensive Agents; Cardiovascular Agents; Cardiovascular Diseases; Chronic Disease; Diuretics; Drug Interactions; Heart Failure; Humans; Hypertension; Kidney Diseases; Socioeconomic Factors

The strategy of primary prevention of coronary heart disease (CHD) needs reconsideration. Recent results of trials of reducing the risk of CHD in those at moderate risk have been inconclusive and disappointing. More may be expected from intervention in those at high risk, and a selective policy is advocated. But, in those at high risk, it is usually necessary to give drugs in order to reduce the risk from hypertension and hypercholesterolaemia. Many currently used and popular drugs have never been submitted to rigourous long-term testing of their safety, although it was only through formal clinical trials that the adverse effects of clofibrate and of thiazides were identified. More, not fewer, clinical trials are needed if we are to avoid new tragedies. A plea is made for the urgent establishment of drug data banks to permit accurate monitoring of changes in the incidence of commonly occurring diseases in relation to the increasing use of drugs for primary prevention of vascular diseases and for social convenience.

Topics: Adrenergic beta-Antagonists; Cardiovascular Agents; Cerebrovascular Disorders; Cholesterol; Clofibrate; Coronary Disease; Diuretics; Humans; Hypertension; Information Systems; Lipids; Risk; Thrombosis

The animal and human pharmacology of several new drugs (prazosin, trimazosin, pirbuterol, and carbazeran) useful in the treatment of congestive heart failure (CHF) is delineated in relation to the pharmacology of other agents employed for CHF management. Prazosin and trimazosin are selective alpha 1-blockers that cause a balanced increase in cardiac output (CO) and reduction in left ventricular filling pressure (LVFP); the reduction in diastolic blood pressure with these drugs is significantly related to increase in treadmill exercise, fall in LVFP, and increase in CO. Pirbuterol is a relatively selective beta 2-agonist with somewhat greater effects on CO than on LVFP. Early promise in CHF therapy is being shown by a novel series of cyclic adenosine monophosphate (cAMP) phosphodiesterase inhibitors with combined direct inotropic and vasodilator effects. Double-blind long-term studies demonstrate persistent efficacy of prazosin and trimazosin in CHF as measured by improvement in New York Heart Association functional class, treadmill exercise performance, and noninvasive measures of cardiac function; these data are supported by studies in which repeat cardiac catheterization has been performed after several months of therapy. Double-blind studies of other CHF drugs are in progress.

Topics: Animals; Asthma; Carbamates; Cardiotonic Agents; Cardiovascular Agents; Clinical Trials as Topic; Drug Evaluation; Drug Evaluation, Preclinical; Ethanolamines; Heart Failure; Hemodynamics; Humans; Hypertension; Piperazines; Prazosin; Quinazolines; Vasodilator Agents

Nearly half of patients do not take their cardiovascular medications as prescribed, resulting in increased morbidity, mortality, and healthcare costs. Mobile and digital technologies for health promotion and disease self-management offer an opportunity to adapt behavioral "nudges" using ubiquitous mobile phone technology to facilitate medication adherence. The Nudge pragmatic clinical trial uses population-level pharmacy data to deliver nudges via mobile phone text messaging and an artificial intelligent interactive chat bot with the goal of improving medication adherence and patient outcomes in three integrated healthcare delivery systems.. The Theory of mHealth, the Expanded RE-AIM/PRISM, and the PRECIS-2 frameworks were used for program planning, implementation, and evaluation, along with a focus on dissemination and cost considerations. During the planning phase, the Nudge study team developed and piloted a technology-based nudge message and chat bot of optimized interactive content libraries for a range of diverse patients. Inclusion criteria are very broad and include patients in one of three diverse health systems who take medications to treat hypertension, atrial fibrillation, coronary artery disease, diabetes, or hyperlipidemia. A target of approximately 10,000 participants will be randomized to one of 4 study arms: usual care (no intervention), generic nudge (text reminder), optimized nudge, and optimized nudge plus interactive AI chat bot. The PRECIS-2 tool indicated that the study protocol is very pragmatic, although there is variability across PRECIS-2 dimensions.. The primary effectiveness outcome is medication adherence defined by the proportion of days covered (PDC) using pharmacy refill data. Implementation outcomes are assessed using the RE-AIM framework, with a particular focus on reach, consistency of implementation, adaptations, cost, and maintenance/sustainability. The project has limitations including limited power to detect some subgroup effects, medication complications (bleeding), and longer-term outcomes (myocardial infarction). Strengths of the study include the diverse healthcare systems, a feasible and generalizable intervention, transparent reporting using established pragmatic research and implementation science frameworks, strong stakeholder engagement, and planning for dissemination and sustainment.. ClinicalTrials.gov NCT03973931 . Registered on 4 June 2019. The study was funded by the NIH; grant number is 4UH3HL144163-02 issued 4/5/19.

Topics: Cardiovascular Agents; Cell Phone; Humans; Hypertension; Medication Adherence; Randomized Controlled Trials as Topic; Text Messaging

A total of 1446 participants, 65- to 74-year-old men diagnosed with abdominal aortic aneurysm (AAA), peripheral arterial disease (PAD) or high blood pressure (HB) in the Viborg Vascular (VIVA) screening trial, were consecutively included and randomised to a telephone counselling (TC) or no TC 3 months after being screened positive. Data from VIVA were linked to data from Danish registers from 2007 to 2016. The primary outcome was a composite outcome of proportion of days covered by statin, antithrombotic drugs and antihypertensive agents and for each specific drug class at 6-month follow-up. The same outcomes were assessed at 12 and 60 months and considered secondary outcomes. Outcome measures are reported as risk differences (RD). There were no differences between the groups in relation to the composite of all three drug classes over 6 months of follow-up, RD = 4.1 (95% CI: -1.0; 9.1). A significant increase in redeemed statin prescriptions was observed in the intervention group at 6 months, RD = 9.8% (CI 95%: 0.5; 19.0). There was no intervention effect observed after 12 and 60 months. TC 3 months after screening improved adherence to statin at 6-month follow-up, but had no effect on the composite treatment, statins, antithrombotic or antihypertensive treatment over 60 months of follow-up.

Topics: Aged; Antihypertensive Agents; Aortic Aneurysm, Abdominal; Cardiovascular Agents; Counseling; Denmark; Diagnostic Screening Programs; Drug Prescriptions; Fibrinolytic Agents; Health Knowledge, Attitudes, Practice; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypertension; Male; Medication Adherence; Peripheral Arterial Disease; Telephone; Time Factors; Treatment Outcome

Heart failure is a chronic disease requiring careful attention to self-care. Patients must follow instructions for diet and medication use to prevent or delay a decline in functional status, quality of life, and expensive care. However, there is considerable heterogeneity in heart failure patients' knowledge of important care routines, their cognition, and their health literacy, which predict the ability to implement self-care. Our interdisciplinary team of cognitive scientists with health literacy expertise, pharmacists, and physicians spent 18 years designing and testing protocols and materials to assist ambulatory heart failure patients with their care. Our approach is theory- as well as problem-driven, guided by our process-knowledge model of health literacy as it relates to self-care among older adult outpatients with either heart failure or hypertension. We used what we had learned from this model to develop a pharmacy-based protocol and tailored patient instruction materials that were the central component of a randomized clinical trial. Our results showed improved adherence to cardiovascular medications, improved health outcomes and patient satisfaction, and direct cost reductions. These results demonstrate the value of our interdisciplinary efforts for developing strategies to improve instruction and communication with attention to health literacy, which are core components of pharmacy and other ambulatory healthcare services. We believe attention to health literacy with medication use will result in improved health outcomes for older adult patients with heart failure and other complex chronic diseases.

Topics: Aged; Cardiovascular Agents; Chronic Disease; Health Literacy; Heart Failure; Humans; Hypertension; Medication Adherence; Patient Satisfaction; Pharmaceutical Services; Pharmacists; Physicians; Quality of Life

Applying fractional flow reserve (FFR) recently helped to assess borderline coronary defects and also facilitates assessment of these lesions. The present study aimed to assess cost-effectiveness of FFR in detection of these borderline lesions.. This cross-sectional study was conducted on140 consecutive patients with 219 diseased arteries who underwent coronary angiography and suffered intermediate coronary lesions.. Of 18 patients who candidate for CABG before FFR, only one patient underwent CABG after determining FFR (P-value<0.05), while 15 patients were scheduled for PCI and 2 patients for medical treatment. Of 122 patients who candidate for PCI, 59 were programmed to underwent PCI after FFR determination(P-value<0.05), while the strategy in 63 patients (47 with one-vessel disease, 15 with two vessel diseases, and 1 with three vessel diseases) was modified to medical treatment. Considering strategy modifying from PCI to medical treatment, 101 stents were saved (P-value<0.05). Also, in change of strategy from CABG to PCI, spending has decreased as much as 77.3% (P-value<0.05). Furthermore, the change of treatment approach from PCI on much number of coronary vessels to PCI on less number of coronary lesions led to saving of 52.2% of costs(P-value<0.05).. In patients with an intermediate coronary lesion, measuring FFR to guide the decision to determine treatment strategy may lead to significant cost savings.

Topics: Adult; Aged, 80 and over; Cardiovascular Agents; Clinical Decision-Making; Coronary Artery Bypass; Coronary Artery Disease; Cost Savings; Cost-Benefit Analysis; Cross-Sectional Studies; Dyslipidemias; Female; Fractional Flow Reserve, Myocardial; Humans; Hypertension; Male; Middle Aged; Percutaneous Coronary Intervention; Pilot Projects; Severity of Illness Index; Smoking

Medication non-adherence is a major impediment to the management of cardiovascular disease risk factors. A better understanding of the modifying factors underlying medication non-adherence among individuals with known cardiovascular disease may inform approaches for addressing non-adherence.. The purpose of this study was to identify demographic and patient characteristics, medical comorbidities, psychosocial factors, and health belief-related factors associated with medication non-adherence among patients with known cardiovascular disease.. We performed secondary analysis of baseline data from a randomized trial.. The study included 405 patients with a diagnosis of hypertension and history of acute myocardial infarction that was diagnosed within a three-year period prior to enrollment.. Baseline demographics and patient characteristics, medical comorbidities, psychosocial factors, health belief-related factors, and patient-reported medication non-adherence were analyzed.. Of 405 patients, 173 (42.7 %) reported medication non-adherence. Factors associated with non-adherence in bivariate analysis included younger age, non-white race, having less than 12 years of education, smoking, financial insecurity, identifying as nervous or tense, higher life chaos score, greater worry about having a myocardial infarction, and greater worry about having a stroke. Using multivariable modeling, we determined that age (OR 0.97 per additional year, 95 % CI, 0.95-0.99), life chaos (OR 1.06 per additional point, 95 % CI, 1.00-1.11), and worry about stroke (OR 1.12 per additional point, 95 % CI, 1.01-1.25) remained significantly associated with self-reported medication non-adherence.. We found that worry about having a stroke, higher life chaos, and younger age were all significantly associated with self-reported medication non-adherence in patients with cardiovascular disease and a history of myocardial infarction. Further research exploring these factors as targets for intervention is needed, as is additional research examining modifiable causes of medication non-adherence among patients with cardiovascular disease.

Topics: Age Factors; Aged; Anxiety; Attitude to Health; Cardiovascular Agents; Comorbidity; Female; Humans; Hypertension; Life Style; Male; Medication Adherence; Middle Aged; Myocardial Infarction; Risk Factors; Self Administration; Self Report; Stroke

Low systolic blood pressure (SBP) is associated with poor outcomes in heart failure and complicates management. In a post hoc analysis, we investigated the efficacy and safety of ivabradine in the SHIFT population divided by tertiles of baseline SBP.. The analysis comprised 2110 patients with SBP <115 mmHg, 1968 with 115≤ SBP <130 mmHg, and 2427 with SBP ≥130 mmHg. Patients with low SBP were younger, had lower ejection fraction, and were less likely to be at target beta-blocker dose than patients in the other SBP groups. Ivabradine was associated with a similar relative risk reduction of the composite outcome in the three SBP groups [SBP <115 mmHg, hazard ratio (HR) = 0.84, 95% confidence interval (CI) 0.72-0.98; 115≤ SBP <130 mmHg, HR = 0.86, 95% CI 0.72 to 1.03; SBP ≥130 mmHg, HR = 0.77, 95% CI 0.66 to 0.92; P interaction = 0.68]. Similar results were found for cardiovascular mortality (P interaction = 0.91), hospitalization because of heart failure (P interaction = 0.79), all-cause mortality (P interaction = 0.90), and heart failure mortality (P interaction = 0.18). There was no evidence for a difference in safety profile according to SBP group.. The efficacy and safety of ivabradine is independent of SBP. This may have implications for the management of HF patients with low SBP and elevated heart rate.

Topics: Aged; Benzazepines; Blood Pressure; Cardiovascular Agents; Double-Blind Method; Female; Heart Failure, Systolic; Humans; Hypertension; Hypotension; Ivabradine; Male; Middle Aged; Prognosis; Systole; Treatment Outcome

Patient adherence is necessary for successful medication therapy. However, highly complex medication regimens may lead to poor adherence, which decreases the effectiveness of treatment and often results in treatment failure, excessive morbidity and mortality, and higher costs. . To examine whether patient adherence can be increased indirectly through reducing medication complexity by (a) pharmaceutical counseling of hospital medical staff and (b) additional information in the discharge letter for the primary care provider (PCP) about the simplified discharge medication. . At the Medical Center Hamburg-Eppendorf, a tertiary care university hospital in Germany, 240 chronically ill inpatients with hypertension, diabetes, and/or dyslipidemia were enrolled in this prospective, semirandomized study. For the intervention group, hospital doctors were counseled by a clinical pharmacist on feasible simplifications of cardiovascular and antidiabetic medications. In 1 randomized subgroup, the PCP received additional explanatory information in the discharge letter. Adherence (self-reporting using the Medication Adherence Rating Scale [MARS-D]) and medication complexity (using the Medication Regimen Complexity Index [MRCI-D]) were recorded at admission to the hospital, discharge from the hospital, and 6 weeks after discharge. Patient quality of life (QoL) and satisfaction with information about medications were assessed at admission and after discharge.  . At discharge, the medication regimen in the intervention group was significantly less complex than in the comparison group. Yet, 6 weeks  after discharge, the complexity of the outpatient medication had increased to values similar to the comparison group, unless the PCP received additional information in the discharge letter. Propensity adjusted complete adherence rates at discharge were slightly, but not significantly, higher in the intervention group than in the comparison group. Within the intervention group, complete adherence was more frequent in the subgroup with additional information for the PCP. Patient QoL and satisfaction with information were comparable in both groups.  . The complexity of cardiovascular and antidiabetic hospital medications can be reduced by counseling the hospital doctors. However, for a sustainable simplification of outpatient medication, the PCPs must receive explicit information about the modifications. Patient adherence was not significantly influenced by this intervention. To verify these results, further research with objective measures of adherence and in patients with other diseases is needed. 

Topics: Adult; Aged; Aged, 80 and over; Cardiovascular Agents; Diabetes Mellitus; Dyslipidemias; Female; Follow-Up Studies; Germany; Hospitals, University; Humans; Hypertension; Hypoglycemic Agents; Male; Medical Staff, Hospital; Medication Adherence; Middle Aged; Patient Discharge; Patient Satisfaction; Pharmacists; Pharmacy Service, Hospital; Professional Role; Prospective Studies; Quality of Life; Young Adult

To investigate the effects of ivabradine in combination with perindopril on cerebral blood flow and endothelial functional activity.. Sixty-four patients with coronary heart disease (CHD) and arterial hypertension (AH) were examined. Group 1 (n = 38) patients took ivabradine in combination with perindopril and Group 2 (n = 26) received metoprolol. At baseline and 8 weeks after therapy, 24-hour blood pressure (BP) monitoring and electrocardiography were done, cerebral blood flow was estimated by Doppler ultrasound, reactive hyperemia and nitroglycerin tests were performed, and plasma nitrite levels were determined.. With a comparable decrease in BP and heart rate in the internal carotid artery basin in both groups over time, there was a fall in peak systolic blood flow velocity; Group 1 showed a reduction in pulsatility index (PI) and systolic/diastolic ratio (ISP). After 8 weeks, there was an increase in endothelium-independent vasodilation and baseline blood flow velocity in the brachial artery in Group 1 and a rise in endothelium-dependent vasodilation in Group 2; in both groups, reactive hyperemia were higher in the brachial artery basin. No changes in nitrite levels were recorded during therapy. There was an inverse correlation between PG and PI in Group 1 and between PG and ISP in Group 2.. By unidirectionally affecting the vasomotor function of the endothelium, ivabradine in combination with perindopril versus metoprolol has a more favorable effect on circulatory resistance and blood flow velocity in the brachiocephalic arteries of patients with CHD and AH.

Topics: Benzazepines; Blood Flow Velocity; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Cardiovascular Agents; Cerebrovascular Circulation; Coronary Disease; Drug Combinations; Electrocardiography; Endothelium, Vascular; Female; Heart Rate; Humans; Hypertension; Ivabradine; Male; Metoprolol; Middle Aged; Perindopril; Research Design; Treatment Outcome; Ultrasonography, Doppler

There are few data that demonstrate a significant effect of aspirin therapy for diabetic patients. To clarify the effect of the primary prevention of aspirin therapy in diabetic patients, the relationship between blood pressure (BP) and the incidence of atherosclerotic events was investigated in participants in the Japanese primary prevention of atherosclerosis with aspirin for diabetes (JPAD) trial.. We divided the JPAD participants according to their systolic (SBP) and diastolic (DBP) BPs at enrollment (SBP ≥140 mmHg and/or DBP ≥90 mmHg: unattained group, SBP <140 mmHg and DBP <90 mmHg: attained group). The incidence of the primary atherosclerotic events, especially cerebrovascular events, was higher in the unattained group than in the attained group. The incidence of cerebrovascular events was higher in the unattained group than in the attained group in patients without aspirin therapy; however, the incidence of cerebrovascular events in the unattained group was as low as the incidence in the attained group in patients undergoing aspirin therapy. Cox proportional hazards analysis revealed that BP level was an independent predictor for cerebrovascular events in diabetic patients.. Aspirin therapy may reduce cerebrovascular events in diabetic patients with higher BP. Aspirin therapy could be an additional strategy as primary prevention for diabetic patients with higher BP.

Topics: Aged; Aspirin; Blood Pressure; Cardiovascular Agents; Cerebrovascular Disorders; Chi-Square Distribution; Diabetes Mellitus, Type 2; Diabetic Angiopathies; Female; Humans; Hypertension; Incidence; Japan; Kaplan-Meier Estimate; Male; Middle Aged; Primary Prevention; Proportional Hazards Models; Prospective Studies; Risk Assessment; Risk Factors; Treatment Outcome

Hypertension is a common comorbidity in patients with heart failure and may contribute to development and course of disease, but the importance of a history of hypertension in patients with prevalent heart failure remains uncertain.. 3078 consecutively hospitalized heart failure patients (NYHA classes II-IV) were screened for the EchoCardiography and Heart Outcome Study (ECHOS). The left ventricular ejection fraction (LVEF) was estimated by 2 dimensional transthoracic echocardiography in all patients and a subgroup of 878 patients had additional data on pulsed wave Doppler assessment of transmitral flow available. A restrictive filling (RF) was defined as a mitral inflow deceleration time ≤140 ms. Patients were followed for a median of 6.8 (Inter Quartile Range 6.6-7.0) years and multivariable Cox regression models were used to assess the risk of all-cause mortality associated with hypertension.. The study population had a mean age of 73 ± 11 years. 39% were female, 27% had a history of hypertension and 48% had a RF. Over the study period, 64% of the population died. Hypertension was not associated with increased risk of mortality, hazard ratio (HR) 0.95 (0.85-1.05). LVEF did not modify this relationship (p for interaction = 0.7), but RF pattern substantially influenced the outcomes associated with hypertension (p for interaction < 0.001); HR 0.75 (0.57-0.99) and 1.41 (1.08-1.84) in patients without and with RF, respectively.. In patients with symptomatic heart failure, a history of hypertension is associated with a substantially increased relative risk of mortality among patients with a restrictive transmitral filling pattern.

Topics: Aged; Aged, 80 and over; Cardiovascular Agents; Chi-Square Distribution; Comorbidity; Double-Blind Method; Echocardiography, Doppler, Pulsed; Female; Heart Failure; Humans; Hypertension; Kaplan-Meier Estimate; Male; Middle Aged; Mitral Valve; Multivariate Analysis; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Risk Assessment; Risk Factors; Scandinavian and Nordic Countries; Stroke Volume; Tetrahydronaphthalenes; Time Factors; Ventricular Function, Left

Aim of the study - to determine efficacy of therapy with the use of ivabradine in patients with functional class (FC) III chronic heart failure (CHF) on the basis of assessment of its action on regulatory adaptive status (RAS). We included into the study 100 patients with FC III CHF at the background of ischemic heart disease (IHD) and/or stage III hypertensive disease (HD) receiving complex therapy (quinapril, torasemide, spironolactone). After randomization group 1 comprised 56 patients (age 62.9+/-1.8 years) who were prescribed slow release metoprolol succinate (59.1+/-4.5 mg/day). Group 2 comprised 44 patients (age 59.4+/-1.3 years) who were prescribed If channel inhibitor ivabradine (12.1+/-2.3 mg/day) if beta-blocker use was not possible. Examination at baseline and in 6 months included treadmillometry with assessment of maximal oxygen consumption (VO2 max) at exercise, echocardiography, 24-hour blood pressure monitoring, measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) in blood plasma. For objective qualitative assessment of the state of RAS we used a test of cardio-respiratory synchronism. Therapy with the use of ivabradine improved structural and functional state of the myocardium, elevated tolerance to exercise, caused positive changes of NT-proBNP concentration in blood plasma and VO2 max at exercise. Thus ivabradine probably can serve as alternative to -adrenoblockers when their use is not possible patients with FC III CHF at the background of IHD and/or stage III HD.

Topics: Benzazepines; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Cardiovascular Agents; Chronic Disease; Drug Monitoring; Drug Therapy, Combination; Echocardiography; Exercise Tolerance; Female; Heart Failure; Heart Rate; Humans; Hypertension; Ivabradine; Male; Middle Aged; Natriuretic Peptide, Brain; Oxygen Consumption; Peptide Fragments; Severity of Illness Index; Treatment Outcome

Elevated resting heart rates have been associated with increased mortality and morbidity in patients with heart failure and decreased left ventricular ejection fraction (EF). It is unclear, though, if this association applies to those with heart failure and preserved EF.. We determined outcome for 685 consecutive patients with a prior diagnosis of heart failure and a preserved EF (>50%) documented on echocardiography at 1 of 3 laboratories. Patients with non-sinus rhythm were excluded from the analysis. We determined adjusted mortality rates at 1 year after the echocardiogram. The mean age of the cohort was 70 ± 11 years. Of the 685 included patients, 87% had a history of hypertension, 50% had diabetes, and the mean EF was 60% ± 6%. All-cause mortality at 1 year was significantly lower in the group with heart rate below 60 beats/min (10%) when compared with the group with heart rates between 60 and 70 beats/min (18%), 71-90 beats/min (20%), and >90 beats/min (35%) (P < .0001). After adjustment for patient history, demographics, laboratory values, and echocardiographic findings, the hazard ratios for total mortality (relative to a heart rate of <60) were 1.26 (95% CI, 0.88-1.80) for HR 60-69, 1.47 (95% CI, 1.02-2.07) for HR 70-90, and 2.00 (95% CI, 1.31-3.04) for HR>90 (P = .01 across all groups).. These data suggest that an elevated resting heart rate is a marker for increased mortality in patients with heart failure and preserved systolic function. Heart rate may be useful in these patients for improved cardiovascular risk assessment.

Topics: Age Factors; Aged; Aged, 80 and over; Cardiovascular Agents; Diabetes Complications; Echocardiography; Female; Heart Failure; Heart Rate; Hospitalization; Humans; Hypertension; Kaplan-Meier Estimate; Life Expectancy; Male; Middle Aged; Prognosis; Risk Assessment; Stroke Volume; Ventricular Function, Left

The discussion about perioperative withdrawal or continuation of angiotensin-converting enzyme inhibitors (ACEI) remains controversial. Should it be continued to avoid peaks in blood pressure and heart rate during anesthesia? Or should it be discontinued the day before to avoid clinically relevant hypotonia? What is the greater risk? Since there are only a few studies dealing with this question, we compared the cardio-circulatory reaction during anesthesia after withdrawal and with continuation of ACEI therapy.. A total of 100 hypertonic patients chronically treated with ACEIs were included in this prospective, randomized, double blind study. The last ACEI medication was given with the premedication in the morning (premed) or on the day before (withdrawal). Blood pressure and heart rate during induction and termination of anesthesia were compared between both groups. A threshold value for vasopressor therapy was determined to be a mean arterial pressure of 60 mmHg.. In the premed group Akrinor was necessary significantly more often and in higher dosages. Nevertheless, following induction the blood pressure and heart rates were significantly lower compared to the withdrawal group. The highest blood pressure and heart rate during induction and termination of anesthesia did not differ between the groups.. The continuation of ACEI therapy in the morning is not associated with a better control of blood pressure and heart rate but causes a more pronounced hypotension which forced a therapy more often. Patients chronically treated with ACEI should receive the ACEI the last time on the day before the operation and not with the premedication in the morning.

Topics: Aged; Anesthesia; Anesthetics, Inhalation; Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Cardiovascular Agents; Double-Blind Method; Drug Combinations; Female; Heart Rate; Humans; Hypertension; Male; Middle Aged; Preoperative Care; Prospective Studies; Theophylline

To evaluate the patency of sirolimus-eluting stents (SES) compared to bare-metal stents (BMS) in the treatment of atherosclerotic renal artery stenosis (RAS).. Between November 2001 to June 2003, 105 consecutive symptomatic patients (53 men; mean age 65.7 years) with RAS were treated with either a bare-metal (n=52) or a drug-eluting (n=53) low-profile Palmaz-Genesis peripheral stent at 11 centers in a prospective nonrandomized trial. The primary endpoint was the angiographic result at 6 months measured with quantitative vessel analysis by an independent core laboratory. Secondary endpoints were technical and procedural success, clinical patency [no target lesion revascularization (TLR)], blood pressure and antihypertensive drug use, worsening of renal function, and no major adverse events at 1, 6, 12, and 24 months.. At 6 months, the overall in-stent diameter stenosis for BMS was 23.9%+/-22.9% versus 18.7%+/-15.6% for SES (p=0.39). The binary restenosis rate was 6.7% for SES versus 14.6% for the BMS (p=0.30). After 6 months and 1 year, TLR rate was 7.7% and 11.5%, respectively, in the BMS group versus 1.9% at both time points in the SES group (p=0.21). This rate remained stable up to the 2-year follow-up but did not reach significance due to the small sample. Even as early as 6 months, both types of stents significantly improved blood pressure and reduced antihypertensive medication compared to baseline (p<0.01). After 6 months, renal function worsened in 4.6% of the BMS patients and in 6.9% of the SES group. The rate of major adverse events was 23.7% for the BMS group and 26.8% for the SES at 2 years (p=0.80).. The angiographic outcome at 6 months did not show a significant difference between BMS and SES. Renal artery stenting with both stents significantly improved blood pressure. Future studies with a larger patient population and longer angiographic follow-up are warranted to determine if there is a significant benefit of drug-eluting stents in treating ostial renal artery stenosis.

Topics: Aged; Angioplasty, Balloon; Antihypertensive Agents; Blood Pressure; Cardiovascular Agents; Europe; Female; Follow-Up Studies; Humans; Hypertension; Kidney Function Tests; Male; Metals; Middle Aged; Prospective Studies; Prosthesis Design; Radiography; Recurrence; Renal Artery; Renal Artery Obstruction; Renal Insufficiency; Research Design; Sirolimus; Stents; Time Factors; Treatment Outcome; Vascular Patency

Several studies have shown that treatment of coronary heart disease (CHD) does not meet the goals set in recommendations. The aim of this study was to investigate the adequacy of CHD drug treatment and secondary prevention measures, particularly with respect to age and gender biases, in a Finnish university hospital setting.. The participant pool consisted of patients in FINCAVAS (Finnish Cardiovascular Study), which is a cohort study recruiting consecutive patients performing a clinical exercise test at Tampere University Hospital, Tampere, Finland. 802 patients (581 men, 221 women) with a prior diagnosis of CHD recruited between October 2001 and December 2004 were included in the analysis.. Only roughly 12% of both men and women had an optimal risk factor profile. High blood pressure and hypercholesterolaemia were more common in women than in men, whereas smoking was more frequent among men. Men used ACE inhibitors (32.9% vs 20.4%, respectively), beta-adrenoceptor antagonists (80.8% vs 68.3%, respectively) and aspirin (acetylsalicylic acid) [69.7% vs 58.8%, respectively] more frequently than women, but the frequency of use of these medications was also not at the recommended levels in men. Risk factor control is poorer in older than younger age groups.. CHD patients, particularly women, who performed an exercise stress test in a university hospital are suboptimally treated.

Topics: Adrenergic beta-Antagonists; Adult; Age Factors; Aged; Angiotensin-Converting Enzyme Inhibitors; Aspirin; Cardiovascular Agents; Cohort Studies; Coronary Disease; Exercise Test; Female; Finland; Hospitals, University; Humans; Hypercholesterolemia; Hypertension; Male; Middle Aged; Practice Patterns, Physicians'; Risk Factors; Sex Factors; Smoking

Thiazide diuretics are known to induce a transient fall of the glomerular filtration rate (GFR), which, in turn, reduces tubular Na(+) load. This tubuloglomerular feedback (TGF) curtails the natriuretic effect of this class of diuretics. Cardiovascular and antiinflammatory therapeutics may interfere with TGF and thereby influence the effect of thiazides once co-administration is clinically indicated.. The effects on GFR and saluresis of hydrochlorothiazide (HCT; 25 mg) monotherapy were measured in healthy volunteers and compared to those obtained during co-administration of the thiazide and a second therapeutic.. In the presence of the ACE inhibitor enalapril (10 mg), the transient fall in the GFR induced by HCT was almost abolished, and Na(+) excretion increased by approximately 30 % as compared to HCT monotherapy. K(+) excretion, however, remained unchanged. Similar results were obtained with the AT II type 1 receptor antagonist candesartan (8 mg): GFR remained stable, Na(+) excretion rose by 35 % and K(+) excretion was not changed. The effect of the Ca(2+) channel blocker amlodipine (5 mg) on GFR and HCT-induced Na(+) excretion equalled that obtained with the AT(1) blocker, yet with this treatment K(+) excretion rose in proportion to Na(+) excretion. The beta-blockers propranolol (80 mg) or bisoprolol (5 mg) reduced GFR but maintained TGF. HCT-induced Na(+) excretion was significantly reduced in the presence of a beta-blocker, whereas K(+) excretion was not changed. The inhibition of cyclooxygenase by diclofenac (50 mg) or rofecoxib (25 mg) significantly reduced the diuretic/natriuretic effect of HCT, but K(+) excretion was unchanged, and TGF was still demonstrable.. In conclusion, AT(1) receptors, as well as the Ca(2+) channels in the smooth muscle cells of the afferent arteriole, are considered prerequisites for TGF function; their blockade increases the diuretic/natriuretic efficacy of thiazide diuretics. In contrast, beta-blockers and COX inhibitors do not interfere directly with TGF. These first dose effects reflect the primary response of the kidney to the drugs. They cannot, however, predict the benefits of long-term treatment.

Topics: Adrenergic beta-Antagonists; Adult; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Calcium Channel Blockers; Cardiovascular Agents; Cross-Over Studies; Cyclooxygenase Inhibitors; Diuretics; Drug Interactions; Drug Therapy, Combination; Electrolytes; Feedback, Physiological; Female; Glomerular Filtration Rate; Heart Failure; Humans; Hydrochlorothiazide; Hypertension; Male; Middle Aged; Natriuresis; Potassium

Electroconvulsive therapy (ECT) is often associated with acute hyperdynamic responses, and we hypothesize that diltiazem can blunt this response. We measured the effect of a 10-mg dose of diltiazem on heart rate and mean arterial pressure during ECT. Furthermore, we assessed seizure duration by using both the cuff method and two-lead electroencephalogram. We studied 18 patients with a randomized, double-blinded, placebo-controlled cross-over study design. Diltiazem significantly reduced heart rate and mean arterial pressure just after medication, and it also significantly reduced the increases in these variables after ECT, as compared with the placebo. The use of diltiazem was, however, associated with a shortened seizure duration, possibly making ECT less effective. Because of the reduction in seizure duration, the routine administration of diltiazem may not be advisable because it can possibly interfere with the psychotherapeutic efficacy of ECT. However, diltiazem medication for ECT is potentially useful for reducing tachycardia and hypertension in high-risk patients.. Diltiazem can blunt acute hyperdynamic responses after electroconvulsive therapy, but seizure duration is also significantly reduced, possibly making this therapy less effective.

Topics: Adult; Aged; Blood Pressure; Cardiovascular Agents; Cross-Over Studies; Diltiazem; Double-Blind Method; Electroconvulsive Therapy; Electroencephalography; Female; Heart Rate; Hemodynamics; Humans; Hypertension; Male; Middle Aged; Seizures; Tachycardia

The arrhythmogenic hazard of adenosine treatment in an emergency room (ER) has not been established. Thus, in this study, we set out to prospectively determine the prevalence and clinical consequences of the arrhythmogenic effects associated with urgent adenosine treatment in the ER. One hundred and sixty consecutive patients treated with adenosine for regular wide or narrow complex tachyarrhythmias at our ER were included in the study. An initial bolus of 3 mg of adenosine was used, up to a maximum dose of 18 mg (mode 6 mg). Proarrhythmia was defined as the new appearance of any brady- or tachyarrhythmia within 1 minute from the bolus administration of adenosine. Of the 160 study patients, 84% had narrow complex tachycardia and 16% had wide complex tachycardia. Adenosine was effective in the diagnosis and/or treatment of the underlying arrhythmia in 92%. The overall prevalence of adenosine-induced proarrhythmia was 13%, including prolonged AV block inducing asystole > 4 seconds (7%), paroxysmal atrial fibrillation (1%) and non-sustained ventricular tachycardia (5%). All adenosine-induced arrhythmias were transient and subsided spontaneously. It is concluded, firstly, that adenosine-induced proarrhythmia proved to be frequent in a consecutive ER series, and included potentially dangerous arrhythmias. Secondly, nevertheless, all adenosine-induced arrhythmias subsided spontaneously and did not require treatment. Therefore, urgent adenosine treatment is safe and can be recommended in an emergency setting, provided a strict protocol of administration under close monitoring by highly trained personnel.

Topics: Adenosine; Adult; Age Distribution; Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Cardiovascular Agents; Comorbidity; Diabetes Mellitus; Drug Therapy, Combination; Drug Tolerance; Electrocardiography; Emergency Service, Hospital; Female; Humans; Hypertension; Hyperthyroidism; Italy; Logistic Models; Male; Middle Aged; Prevalence; Prospective Studies; Pulmonary Disease, Chronic Obstructive; Sex Distribution; Tachycardia; Treatment Outcome

Although postprandial and orthostatic hypotension are commonly observed in nursing home residents, their reproducibility, relationship to each other, and association with chronic use of cardiovascular medications are poorly understood.. We examined blood pressure (BP) and heart rate (HR) before and after postural change, and before and after a 419-kcal meal in 22 nursing home residents (mean age 89 +/- 5 (SD) years), each on two occasions, to determine reproducibility changes. These studies were repeated in 17 residents, with and without previous administration of cardiovascular medications, in random order.. Hebrew Rehabilitation Center for the Aged, an academic long-term care facility.. Systolic BP declined an average (+/- SE) of 16 +/- 4 mm Hg and 12 +/- 4 mm Hg during the first and second meal studies, respectively. Mean intra-class correlation of postprandial systolic BP values during the two studies was 0.88 (95% CI 0.85-0.97). Systolic BP increased significantly during the first posture test to a maximum of 8 +/- 6 mm Hg at 6 minutes. There was no significant difference over time in postural systolic BP between the two tests. Repeated postural studies showed a mean intra-class correlation of 0.72 (95% CI 0.62-0.92) for changes in systolic BP. Cardiovascular medications had no additional effect on postprandial or orthostatic BP and HR changes. During the first studies, 10 subjects had postprandial hypotension, and three subjects had orthostatic hypotension, but only two of 22 subjects had both.. Patterns of systolic BP response to meals or postural change are reproducible. BP responses to meals and postural change seem to be unaffected by potentially hypotensive medications in chronic users. Postprandial hypotension is distinct from orthostatic hypotension, occurring more commonly than orthostatic hypotension and infrequently together in the same patients.

Topics: Aged; Aged, 80 and over; Analysis of Variance; Blood Pressure; Boston; Cardiovascular Agents; Eating; Female; Homes for the Aged; Humans; Hypertension; Hypotension, Orthostatic; Male; Nursing Homes; Posture; Reproducibility of Results; Time Factors

Over an eight year period (1985-1993), we treated 424 patients with various forms of cardiovascular disease by adding coenzyme Q10 (CoQ10) to their medical regimens. Doses of CoQ10 ranged from 75 to 600 mg/day by mouth (average 242 mg). Treatment was primarily guided by the patient's clinical response. In many instances, CoQ10 levels were employed with the aim of producing a whole blood level greater than or equal to 2.10 micrograms/ml (average 2.92 micrograms/ml, n = 297). Patients were followed for an average of 17.8 months, with a total accumulation of 632 patient years. Eleven patients were omitted from this study: 10 due to non-compliance and one who experienced nausea. Eighteen deaths occurred during the study period with 10 attributable to cardiac causes. Patients were divided into six diagnostic categories: ischemic cardiomyopathy (ICM), dilated cardiomyopathy (DCM), primary diastolic dysfunction (PDD), hypertension (HTN), mitral valve prolapse (MVP) and valvular heart disease (VHD). For the entire group and for each diagnostic category, we evaluated clinical response according to the New York Heart Association (NYHA) functional scale, and found significant improvement. Of 424 patients, 58 per cent improved by one NYHA class, 28% by two classes and 1.2% by three classes. A statistically significant improvement in myocardial function was documented using the following echocardiographic parameters: left ventricular wall thickness, mitral valve inflow slope and fractional shortening. Before treatment with CoQ10, most patients were taking from one to five cardiac medications. During this study, overall medication requirements dropped considerably: 43% stopped between one and three drugs. Only 6% of the patients required the addition of one drug. No apparent side effects from CoQ10 treatment were noted other than a single case of transient nausea. In conclusion, CoQ10 is a safe and effective adjunctive treatment for a broad range of cardiovascular diseases, producing gratifying clinical responses while easing the medical and financial burden of multidrug therapy.

Topics: Cardiomyopathy, Dilated; Cardiovascular Agents; Cardiovascular Diseases; Coenzymes; Diastole; Drug Therapy, Combination; Echocardiography; Female; Follow-Up Studies; Heart Function Tests; Heart Valve Diseases; Humans; Hypertension; Male; Middle Aged; Mitral Valve Prolapse; Myocardial Ischemia; Treatment Outcome; Ubiquinone

A placebo is a pharmacologically inactive substance that can have a therapeutic effect if administered to a patient who believes that he or she is receiving an effective treatment. It is generally admitted that the placebo effect decreases blood pressure in 20% to 30%, when evaluated by casual sphygmomanometer or ambulatory systems. In order to evaluate the occurrence of a placebo effect in cardiovascular pharmacology, we analysed two studies. One study included ten mild-to-moderate hypertensive patients, and consisted of two submaximal exercise tests separated by a single oral administration of the placebo. The other study included six healthy volunteers, receiving an oral placebo during ten days. The placebo was in both case presented as an effective antihypertensive agent. Any change on blood pressure and heart rate, both at rest and during exercise, was observed before and three hours after the placebo. After ten days of placebo administration, no statistically significant change in blood pressure or heart rate was obtained. Nor was any statistical difference observed in catecholamine plasma levels, either three hours or ten days after oral administration of the placebo. The second study did not show any evidence of changes in lymphocytic beta-adrenoceptor density after ten days of placebo. The results of these pilot studies suggest that the use of a placebo group in cardiovascular clinical pharmacology should be reconsidered. The real occurrence and characteristics of a placebo effect should be evaluated by a complementary study.

Topics: Blood Pressure; Cardiovascular Agents; Catecholamines; Double-Blind Method; Heart Rate; Humans; Hypertension; Lymphocytes; Placebo Effect; Placebos; Receptors, Adrenergic, beta; Single-Blind Method

The pharmacologic approach to coronary protection, defined here as the prevention or delay of sudden death and myocardial infarction (without negatively affecting noncardiac mortality), is critically discussed. The value of pharmacologically treating mild hypertension and mild hypercholesterolemia is questioned, and the need for well-designed, randomized clinical trials with definitive endpoints to determine a drug's cardioprotective capability is emphasized. Based on such studies, it is concluded that some (but perhaps not all) beta-receptor antagonists as well as aspirin have been shown to protect against sudden cardiac death. Trials of thiazide diuretics, calcium antagonists, and angiotensin-converting enzyme inhibitors have not shown a reduction in sudden cardiac death, despite having individual benefits with respect to other aspects of cardiovascular disease. The demonstration that some beta blockers are cardioprotective is discussed in terms of the pathophysiology of sudden cardiac death, and differences in the pharmacokinetic profiles of individual agents.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Animals; Calcium Channel Blockers; Cardiovascular Agents; Death, Sudden, Cardiac; Europe; Humans; Hypercholesterolemia; Hypertension; Myocardial Infarction

The animal and human pharmacology of several new drugs (prazosin, trimazosin, pirbuterol, and carbazeran) useful in the treatment of congestive heart failure (CHF) is delineated in relation to the pharmacology of other agents employed for CHF management. Prazosin and trimazosin are selective alpha 1-blockers that cause a balanced increase in cardiac output (CO) and reduction in left ventricular filling pressure (LVFP); the reduction in diastolic blood pressure with these drugs is significantly related to increase in treadmill exercise, fall in LVFP, and increase in CO. Pirbuterol is a relatively selective beta 2-agonist with somewhat greater effects on CO than on LVFP. Early promise in CHF therapy is being shown by a novel series of cyclic adenosine monophosphate (cAMP) phosphodiesterase inhibitors with combined direct inotropic and vasodilator effects. Double-blind long-term studies demonstrate persistent efficacy of prazosin and trimazosin in CHF as measured by improvement in New York Heart Association functional class, treadmill exercise performance, and noninvasive measures of cardiac function; these data are supported by studies in which repeat cardiac catheterization has been performed after several months of therapy. Double-blind studies of other CHF drugs are in progress.

Topics: Animals; Asthma; Carbamates; Cardiotonic Agents; Cardiovascular Agents; Clinical Trials as Topic; Drug Evaluation; Drug Evaluation, Preclinical; Ethanolamines; Heart Failure; Hemodynamics; Humans; Hypertension; Piperazines; Prazosin; Quinazolines; Vasodilator Agents

Cardiovascular disease remains the leading cause of death worldwide and brings a heavy burden. However, the development of cardiovascular drug clinical trials in China remains unclear. The purpose of this study was to identify the status of clinical trials of cardiovascular drugs in China and provide a reference for stakeholders' decisions.. Data were collected from the National Medical Products Administration (NMPA) Registration and Information Disclosure Platform for Drug Clinical Trials before July 1, 2021. We collected all information about clinical trials, including study design, and leading unit. The landscape of cardiovascular drug clinical trials was analyzed by the characteristics, time trends, indications, and geographical distribution.. A total of 1666 cardiovascular drug clinical trials were launched from 2009 to 2021 in China. Bioequivalence/bioavailability studies accounted for the most significant proportion (1099 [65.97%]), followed by phase I (296 [17.77%]), phase III (135 [8.10%]), phase II (118 [7.08%]), and phase IV trials (18 [1.08%]). Initiated trials increased by 23.45% annually from 2009 to 2020. Trials of hypertension accounted for the most significant number, followed by coronary heart disease, dyslipidemia, and heart failure. Most trials (66.68%) were conducted in eastern China, followed by the central and western regions, showing a regional disparity as leading units.. Despite the significant progress of cardiovascular drug clinical trials in China, there is still a long way to innovative drug research and development, requiring persistent policy support and more investment. Innovation, quality, efficiency, and equity need to be carefully considered by all stakeholders in clinical trials.

Topics: Cardiovascular Agents; Cardiovascular Diseases; China; Humans; Hypertension; Research Design

Blood pressure is not optimally reduced in 3 of 4 patients with hypertension (HTN) in the United States.. We analyzed for factors associations with premorbid non-adherence to HTN medications in acute stroke patients.. This cross-sectional study included 225 acute stroke patients with self-reported adherence to HTM medications in a stroke registry in the Southeastern United States. We defined medication non-adherence as < 90% of prescribed. Logistic regression analyzed demographic and socioeconomic factors for prediction of adherence.. There were 145 (64%) patients with adherence and 80 (36%) with non-adherence. The likelihood of adherence to HTN medications was decreased among black patients, OR 0.49 (95% CI 0.26-0.93), p = 0.03, and those without health insurance, OR 0.29 (95% CI 0.13-0.64), p = 0.002. Specific reasons for non-adherence were high medication cost in 26 (33%), side effects in 8 (10%), and other unspecified reasons in 46 (58%) patients.. In this study, adherence to HTN medications was significantly lower among black patients and those without health insurance.

Topics: Antihypertensive Agents; Cardiovascular Agents; Cross-Sectional Studies; Humans; Hypertension; Medication Adherence; Stroke; United States

In Namibia, the prevalence of hypertension among women and men aged 35−64 years is high, ranging from 44% to 57%. In this study, we aimed to determine adherence and predictors to antihypertensive therapy in Khomas region, Namibia. A cross-sectional study was performed to consecutively sample 400 patients from urban and peri-urban settings in Namibia. Results were validated using the Hill-Bone Compliance to High Blood Pressure Therapy Scale. Crude associations between predictors of adherence and compliance were tested using the Pearson chi-square test. A multivariable logistic regression analysis was then performed on adherence variables found to be significant to adjust for confounders, and the results are presented as adjusted odds ratios (aOR) with 95% confidence intervals. A total of 400 patients participated in this study. The participants’ mean age and standard deviation were Mean ± SD = 48.9 ± 12.5. In this study, 351 (87.7%) patients were estimated to have good adherence. Education, employment, and the presence of other chronic diseases were associated with adherence. Following multivariate adjustment, the following factors were significantly associated and are therefore predictors of adherence (95%CI, p < 0.005): receiving enough medication at last check-up until next one (OR = 5.44, CI 1.76−16.85), lack of encouragement from family and friends (OR = 0.11 (0.03−0.42)), and attendance of follow-ups on schedule (OR = 8.49, CI = 3.82−18.85). The success of hypertension therapy is dependent on the healthcare systems and healthcare professionals in supplying enough medication, support of friends/family, and maintaining scheduled follow-ups. A combination of interventions using low-cost mobile technology led by healthcare professionals could be endorsed. To fully practice universal access to medication, public and private hospitals in Namibia should collaborate.

Topics: Antihypertensive Agents; Cardiovascular Agents; Cross-Sectional Studies; Female; Humans; Hypertension; Male; Medication Adherence; Namibia

We aim to assess the association of cardiovascular medications with outcomes of patients referred to the diagnostic heart failure (HF) clinic with symptoms or signs of possible HF, raised N-terminal pro-brain-type natriuretic peptide (NT-proBNP) but no evidence of HF on transthoracic echocardiography (TTE).. Data were collected prospectively into the Sheffield HEArt Failure (SHEAF) registry between April 2012 and January 2020. The inclusion criteria were symptoms or signs suggestive of HF, NT-proBNP >400 pg/mL, but no evidence of HF on TTE. Cox proportional-hazards regression model was used to investigate the association between the survival time of patients and different cardiovascular medications. The outcome was defined as all-cause mortality.. From the SHEAF registry, we identified 1766 patients with raised NT-proBNP with no evidence of HF on TTE. Survival was higher among the younger patients, and among those with hypertension or atrial fibrillation (AF). Mortality was increased with male gender, valvular heart disease and chronic kidney disease. Using univariate Cox proportional-hazards regression, the only cardiac therapeutic agent independently associated with all-cause mortality was beta-blocker (HR 0.86; 95% CI: 0.77 to 0.97; p=0.02). The use of beta-blockers was significantly higher in patients with AF (63% vs 39%, p<0.01) and hypertension (51% vs 42%, p<0.01). However, using multivariate Cox proportional-hazards regression to adjust for all variables associated with mortality, the influence of beta-blockers became non-significant (HR 0.96; 95% CI: 0.85 to 1.1, p=0.49).. When all variables associated with mortality are considered, none of the cardiovascular agents are associated with the improved survival of patients with suspected HF, raised NT-proBNP but no HF on echocardiography.

Topics: Adrenergic beta-Antagonists; Atrial Fibrillation; Cardiovascular Agents; Heart Failure; Humans; Hypertension; Male; Natriuretic Peptide, Brain; Peptide Fragments; Registries

Patients and medical professionals have a common misconception that cardiovascular diseases (CVD) predominantly affect men, which can lead to less prescribing of cardiovascular drugs to women. This study examined whether there were sex differences in the administration of cardiovascular (CV) drugs in patients admitted to the intensive care unit of the Internal Medicine Clinic of Foča University Hospital (ICFUH).. The study comprised 332 patients hospitalized at the ICFUH from January 1st to June 30th, 2019. The following data on leading CVD and risks related to CV drug administration were collected: age, hyperlipidemia (HLD), diabetes mellitus (DM), chronic kidney disease (CKD), liver disease (LD), heart failure (HF), hypertension (HTN), myocardial infarction (MI), and stroke (S). The amount of the CV drugs of interest (statins, antiplatelet drugs, calcium channel blockers, ACE inhibitors, beta blockers, diuretics) administered during hospitalization was expressed as the Defined Daily Dose (DDD)/100 bed-days (BD) for patients of both sexes separately.. During hospitalization in the intensive care unit of ICFUH, female patients were less likely to be treated with statins than male patients (30.1 vs. 57.5 DDD/100 BD, P<0.05). There was no difference between sexes regarding the use of antihypertensive drugs. Women were less likely to be treated by antiplatelet therapy, more precisely by acetylsalicylic acid (30.4 vs. 36.9 DDD/100 BD, P<0.05).. Our study indicates that there were sex differences in CV drug administration in ICFUH. Presuming that drugs used during hospitalization were at least partially a continuation of the previous therapy prescribed by the family doctor, it is possible that such differences exist in primary care.

Topics: Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Cardiovascular Agents; Female; Humans; Hypertension; Male; Myocardial Infarction; Sex Characteristics

Topics: Cardiovascular Agents; Cardiovascular Diseases; Humans; Hypertension; Risk Factors

Farnesol (FAR) is a sesquiterpene alcohol with a range of reported biological effects including cardioprotective, antioxidant and antiarrhythmic properties. However, due to its volatility, the use of drug incorporation systems, such as cyclodextrins, have been proposed to improve its pharmacological properties. Thus, the aim of this study was to evaluate and characterize the cardiovascular effects of FAR alone, and to investigate the antihypertensive effects of FAR complexed with β-cyclodextrin (βCD) in rats. Mean arterial pressure (MAP) and heart rate (HR) were measured before and after intravenous administration of FAR (0,5; 2,5; 5 and 7,5 mg/kg) in normotensive rats, and after oral acute administration (200 mg/kg) of FAR and FAR/βCD complex in NG-nitro-L-arginine-methyl-ester (L-NAME) hypertensive rats. In normotensive animals, FAR induced dose-dependent hypotension associated with bradycardia. These effects were not affected by pre-treatment with L-NAME or indomethacin (INDO), but were partially attenuated by atropine. Pre-treatment with hexamethonium (HEXA) only affected hypotension. In the hypertensive rats, FAR/βCD potentialized the antihypertensive effect when compared to FAR alone. Molecular docking experiments demonstrated for the first time that FAR has affinity to bind to the M

Topics: Animals; Arterial Pressure; beta-Cyclodextrins; Blood Pressure; Bradycardia; Cardiovascular Agents; Dose-Response Relationship, Drug; Enzyme Inhibitors; Farnesol; Heart Rate; Hypertension; Male; Molecular Docking Simulation; NG-Nitroarginine Methyl Ester; Nitric Oxide Synthase; Rats; Rats, Wistar

The coronavirus disease 19 (COVID-19) recently became one of the leading causes of death worldwide, similar to cardiovascular disease (CVD). Coexisting CVD may influence the prognosis of patients with COVID-19.. We analyzed the impact of CVD and the use of cardiovascular drugs on the in-hospital course and mortality of patients with COVID-19.. We retrospectively studied data for consecutive patients admitted to our hospital, with COVID-19 between March 6th and October 15th, 2020.. 1729 patients (median interquartile range age 63 [50-75] years; women 48.8%) were included. Overall, in-hospital mortality was 12.9%. The most prevalent CVD was arterial hypertension (56.1%), followed by hyperlipidemia (27.4%), diabetes mellitus (DM) (25.7%), coronary artery disease (16.8%), heart failure (HF) (10.3%), atrial fibrillation (13.5%), and stroke (8%). Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) were used in 25.0% of patients, β-blockers in 40.7%, statins in 15.6%, and antiplatelet therapy in 19.9%. Age over 65 years (odds ratio [OR], 6.4; 95% CI, 4.3-9.6), male sex (OR, 1.4; 95% CI, 1.1-2.0), pre-existing DM (OR, 1.5; 95% CI, 1.1-2.1), and HF (OR, 2.3; 95% CI, 1.5-3.5) were independent predictors of in-hospital death, whereas treatment with ACEIs/ARBs (OR, 0.4; 95% CI, 0.3-0.6), β-blockers (OR, 0.6; 95% CI, 0.4-0.9), statins (OR, 0.5; 95% CI, 0.3-0.8), or antiplatelet therapy (OR, 0.6; 95% CI: 0.4-0.9) was associated with lower risk of death.. Among cardiovascular risk factors and diseases, HF and DM appeared to increase in-hospital COVID-19 mortality, whereas the use of cardiovascular drugs was associated with lower mortality.

Topics: Aged; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Cardiovascular Agents; Cardiovascular Diseases; COVID-19; Female; Hospital Mortality; Hospitals; Humans; Hypertension; Male; Middle Aged; Poland; Registries; Retrospective Studies; SARS-CoV-2

Topics: Cardiovascular Agents; Humans; Hypertension; India; Pharmaceutical Preparations

Myocardial fibrosis is a hallmark of cardiac remodeling and functionally involved in heart failure development, a leading cause of deaths worldwide. Clinically, no therapeutic strategy is available that specifically attenuates maladaptive responses of cardiac fibroblasts, the effector cells of fibrosis in the heart. Therefore, our aim was to develop novel antifibrotic therapeutics based on naturally derived substance library screens for the treatment of cardiac fibrosis.. Antifibrotic drug candidates were identified by functional screening of 480 chemically diverse natural compounds in primary human cardiac fibroblasts, subsequent validation, and mechanistic in vitro and in vivo studies. Hits were analyzed for dose-dependent inhibition of proliferation of human cardiac fibroblasts, modulation of apoptosis, and extracellular matrix expression. In vitro findings were confirmed in vivo with an angiotensin II-mediated murine model of cardiac fibrosis in both preventive and therapeutic settings, as well as in the Dahl salt-sensitive rat model. To investigate the mechanism underlying the antifibrotic potential of the lead compounds, treatment-dependent changes in the noncoding RNAome in primary human cardiac fibroblasts were analyzed by RNA deep sequencing.. High-throughput natural compound library screening identified 15 substances with antiproliferative effects in human cardiac fibroblasts. Using multiple in vitro fibrosis assays and stringent selection algorithms, we identified the steroid bufalin (from Chinese toad venom) and the alkaloid lycorine (from. We identified the molecules bufalin and lycorine as drug candidates for therapeutic applications in cardiac fibrosis and diastolic dysfunction.

Topics: Amaryllidaceae Alkaloids; Animals; Apoptosis; Bufanolides; Cardiomyopathies; Cardiovascular Agents; Cell Proliferation; Cells, Cultured; Diastole; Disease Models, Animal; Extracellular Matrix; Fibroblasts; Fibrosis; High-Throughput Screening Assays; Humans; Hypertension; Male; Mice, Inbred C57BL; MicroRNAs; Myocardium; Phenanthridines; Rats, Inbred Dahl; Selenoprotein P; Ventricular Function, Left

Topics: Acute Coronary Syndrome; Adult; Cardiac Catheterization; Cardiovascular Agents; Cardiovascular Diseases; Combined Modality Therapy; Coronavirus Infections; COVID-19; Diabetes Mellitus, Type 2; Diagnosis, Differential; Extracorporeal Membrane Oxygenation; Female; Heart Failure; Heart Transplantation; Humans; Hyperlipidemias; Hypertension; Hypertrophy, Left Ventricular; Immunosuppressive Agents; Intra-Aortic Balloon Pumping; Kidney Transplantation; Male; Middle Aged; Pandemics; Pericarditis; Pneumonia, Viral; Postoperative Complications; Respiration, Artificial; Respiratory Distress Syndrome; Shock, Cardiogenic

Topics: AMP-Activated Protein Kinases; Animals; Arterial Pressure; Cardiovascular Agents; Disease Models, Animal; Energy Metabolism; Fatty Acids; Glucose; Hypertension; Hypertrophy, Left Ventricular; Metformin; Myocardium; Oxidation-Reduction; Oxidative Stress; Rats, Inbred SHR; Rats, Inbred WKY; TOR Serine-Threonine Kinases; Ventricular Function, Left; Ventricular Remodeling

Ranolazine is approved for patients with chronic stable angina but has not been formally studied in patients with refractory angina pectoris (RAP). Patients with RAP have limited therapeutic options and significant limitations in their quality of life. The Ranolazine Refractory Angina Registry was designed to evaluate the safety, tolerability, and effectiveness of ranolazine in RAP patients in order to expand treatment options for this challenging patient population. Using an extensive prospective database, we enrolled 158 consecutive patients evaluated in a dedicated RAP clinic. Angina class, medications, major adverse cardiac events including death, myocardial infarction, and revascularization were obtained at 12, 24, and 36 months. At 3 years, 95 (60%) patients remained on ranolazine. A ≥2 class improvement in angina was seen in 48% (38 of 80 patients with known Canadian Cardiovascular Society class) of those who remained on ranolazine. Discontinuation due to side effects, ineffectiveness, cost, and progression of disease were the principle reasons for discontinuation, but primarily occurred within the first year. In conclusion, ranolazine is an effective antianginal therapy at 3-year follow-up in patients with RAP and may reduce cardiac readmission.

Topics: Aged; Angina Pectoris; Cardiovascular Agents; Constipation; Deprescriptions; Diabetes Mellitus; Disease Progression; Dizziness; Drug Costs; Dyslipidemias; Edema; Female; Humans; Hypertension; Male; Medication Adherence; Middle Aged; Mortality; Myocardial Infarction; Myocardial Revascularization; Nausea; Ranolazine; Registries; Smoking; Treatment Failure; Treatment Outcome

Congestive heart failure (CHF) is the most important cause of death in patients with atrial fibrillation (AF). We aimed to study the association between cardiovascular drugs in AF patients and incident CHF. The study population included all adults (n = 120 756) aged ≥45 years diagnosed with AF in Sweden diagnosed for the period 1998-2006. Outcome was incident congestive heart failure (follow-up 2007-2015) in AF patients. Associations between treatment with cardiovascular pharmacotherapies and CHF were evaluated using Cox regression to estimate hazard ratios (HRs) with 95% CIs, after adjustment for age, sociodemographic variables, and comorbidities. During a mean 5.3 years (SD 3.0) of follow-up, there were 28 257 (23.4%) incident cases of CHF. Treatment with beta-1-selective and non-selective beta-blockers and statins was associated with lower risks of incident CHF in men, HR, (95% CI); 0.90, (0.87-0.94); 0.90, (0.84-0.97), and 0.94, (0.90-0.99), respectively. Only beta-1-selective beta-blockers were protective in women 0.94 (0.91-0.98). Treatment with loop diuretics, potassium-saving agents, ACE inhibitors, and angiotensin receptor blockers was associated with a higher risk of CHF. For men, treatment with heart-active calcium channel blockers also led to a higher risk of CHF. In conclusion, we found that beta-blockers, in particular, but also statins were associated with lower risk of incident CHF in patients with AF.

Topics: Atrial Fibrillation; Cardiovascular Agents; Female; Heart Failure; Humans; Hypertension; Male; Middle Aged; Sweden

This study aimed to investigate whether specific medications used in the treatment chronic diseases affected either the development and/ or severity of coronavirus disease 2019 (COVID-19) in a cohort of 610 COVID-19 cases and 48,667 population-based controls from Zhejiang, China. Using a cohort of 578 COVID-19 cases and 48,667 population-based controls from Zhejiang, China, we tested the role of usage of cardiovascular, antidiabetic, and other medications on risk and severity of COVID-19. Analyses were adjusted for age, sex, and body mass index and for presence of relevant comorbidities. Individuals with hypertension taking calcium channel blockers had significantly increased risk (odds ratio (OR) = 1.73, 95% confidence interval (CI) 1.2-2.3) of manifesting symptoms of COVID-19, whereas those taking angiotensin receptor blockers and diuretics had significantly lower disease risk (OR = 0.22, 95% CI 0.15-0.30 and OR = 0.30, 95% CI 0.19-0.58, respectively). Among those with type 2 diabetes, dipeptidyl peptidase-4 inhibitors (OR = 6.02, 95% CI 2.3-15.5) and insulin (OR = 2.71, 95% CI 1.6-5.5) were more and glucosidase inhibitors were less prevalent (OR = 0.11, 95% CI 0.1-0.3) among with patients with COVID-19. Drugs used in the treatment of hypertension and diabetes influence the risk of development of COVID-19, but, not its severity.

Topics: Adult; Aged; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Calcium Channel Blockers; Cardiovascular Agents; Case-Control Studies; Comorbidity; COVID-19; Diabetes Mellitus, Type 2; Dipeptidyl-Peptidase IV Inhibitors; Humans; Hypertension; Hypoglycemic Agents; Insulin; Middle Aged; Risk Factors; SARS-CoV-2; Severity of Illness Index

Topics: Cardiovascular Agents; Humans; Hypertension; Medication Adherence; Reminder Systems; Text Messaging

Incidence of coronary artery disease at the younger age is rising. We studied the prevalence, clinical spectrum and long term outcome of ST-segment elevation myocardial infarction in young.. This is a prospective observational study, performed at a tertiary care center from January 2015 to June 2016. Of the total 977 consecutive patients with ST segment elevation myocardial infarction (STEMI), 130 patients aged ≤45 years were included. All patients were followed-up for at least 1-year from the index admission.. The overall prevalence of STEMI among younger patients was 12.8%. There was male dominance (96.8%). Smoking (37.6%) was observed to be the most common risk factor for young STEMI, followed by diabetes mellitus (16.8%) and hypertension (16%). Younger patients with acute MI had preponderance to anterior wall (68.8%), single-vessel disease (50%) and left anterior descending artery being the culprit lesion (67.3%). Near normal/normal coronary arteries were observed in 12.9% of cases. The most commonly used management strategy was mechanical revascularisation (43.2%), followed by thrombolysis (28.8%) and medical management (28%). The overall mortality and combined MACCE rates at 1 year were 3.2% and 18.4% respectively. Outcome was better in patients who received mechanical revascularization/thrombolysis than those who received medical management only, with a lower MACCE rates (hazard ratio: 0.36; 95% CI: 0.16-0.8, p = 0.01.. The young MI patients are unique in having male dominance, better outcome, more of single-vessel disease with significant number of normal coronaries, better response to mechanical as well as pharmacological revascularization.

Topics: Adult; Age of Onset; Anterior Wall Myocardial Infarction; Cardiovascular Agents; Coronary Artery Disease; Diabetes Mellitus; Female; Humans; Hypertension; India; Male; Middle Aged; Myocardial Revascularization; Prevalence; Prospective Studies; Risk Assessment; Risk Factors; Sex Distribution; Smoking; ST Elevation Myocardial Infarction; Thrombolytic Therapy; Time Factors; Treatment Outcome; Young Adult

Low density lipoprotein cholesterol (LDL-C) is a primary risk factor for atherosclerosis, but it is also associated with elevated blood pressure (BP) and future development of hypertension. We examined the relationship between LDL-C and haemodynamic variables in normotensive and never-treated hypertensive subjects.. We recruited 615 volunteers (19-72 years) without lipid-lowering and BP-lowering medication. Supine haemodynamics were recorded using continuous radial pulse wave analysis, whole-body impedance cardiography, and single channel electrocardiogram. The haemodynamic relations of LDL-C were examined using linear regression analyses with age, sex, body mass index (BMI) (or height and weight as appropriate), smoking status, alcohol use, and plasma C-reactive protein, sodium, uric acid, high density lipoprotein cholesterol (HDL-C), triglycerides, estimated glomerular filtration rate, and quantitative insulin sensitivity check index as the other included variables.. LDL-C is independently associated with BP via systemic vascular resistance and wave reflection. These results suggest that LDL-C may play a role in the pathogenesis of primary hypertension.

Topics: Adult; Aged; Blood Pressure; Cardiography, Impedance; Cardiovascular Agents; Cholesterol, LDL; Female; Hemodynamics; Humans; Hypertension; Male; Middle Aged; Pulse Wave Analysis; Risk Factors; Vascular Resistance; Young Adult

Cardiac hypertrophy and heart failure are characterized by increased late sodium current and abnormal Ca. Our study demonstrates that inhibition of late sodium current with ranolazine improves pressure overload-induced cardiac hypertrophy and systolic and diastolic function by restoring Na

Topics: Animals; Calcium; Cardiomegaly; Cardiovascular Agents; Cell Line; Fibrosis; Heart Failure; Hypertension; Male; Mice; Mice, Inbred C57BL; Myocytes, Cardiac; Random Allocation; Ranolazine; Sodium

Although many studies have reported the effects of AT1 receptor on dietary salt overload, the role of AT2 receptor in this model is far from completely elucidated. The present study aimed to better understand the role of AT2 receptor in cardiac structure alterations in response to chronic high salt intake in rats.. Male Wistar rats were fed a normal or high salt diet from weaning until 18 weeks of age. Both groups were subdivided into two groups. Starting at 7 weeks of age, rats were treated with or without compound 21 (0.3 mg/kg/day, n = 16), an AT2 receptor agonist. Metabolics and structural parameters were measured. BP, transverse cardiomyocyte and intersticial fibrose was higher in animals fed with high salt diet compared with normal salt fed animals.. Compound 21 prevented the development of cardiac hypertrophy and fibrosis, reduced the increase in blood pressure and prevented the lower weight gain in animals fed a high salt diet.

Topics: Animals; Blood Pressure; Cardiomegaly; Cardiovascular Agents; Disease Models, Animal; Fibrosis; Hypertension; Male; Myocytes, Cardiac; Rats, Wistar; Receptor, Angiotensin, Type 2; Signal Transduction; Sodium Chloride, Dietary; Sulfonamides; Thiophenes; Ventricular Remodeling; Weight Gain

Whether the reduction of heart rate with ivabradine (IVA) could affect sympathetic activation and cardiac innervation in heart failure (HF) remains unknown.. The present study assessed the chronic effects of IVA and β-blocker on the systemic and local sympathetic nervous systems of hypertensive animals with HF.. The Dahl salt-sensitive rats received chronic IVA, bisoprolol (BIS), or placebo (CTL) therapy. The survival of the animal models with IVA and BIS significantly improved (median; 19.7 in IVA and 19.7 in BIS vs 17.0 weeks in CTL, P < .001). A similar decrease in 24-hour heart rate (mean; 305 in IVA and 329 in BIS vs 388 beats/min in CTL, P < .001) without effect on blood pressure, and an improvement in the left ventricular dysfunction (mean fractional shortening; 56.7% in IVA and 47.8% in BIS vs 39.0% in CTL, P < .001) were observed in the animals with IVA and BIS. However, a negative inotropic effect was only observed in the animals with BIS. Excessive urinary noradrenaline excretion in animals with CTL was only suppressed with the use of IVA (mean; 1.35 μg/d in IVA and 1.95 μg/d in BIS vs 2.27 μg/d in CTL, P = .002). In contrast, atrial noradrenaline and acetylcholine depletion in the animals with CTL improved and the tyrosine hydroxylase expression in the both atria were restored with the use of both IVA and BIS.. IVA therapy improved the survival of hypertensive animals with HF. Furthermore, it was associated with the amelioration of systemic sympathetic activation and cardiac sympathetic and parasympathetic nerve innervations. Chronic β-blocker therapy with negative inotropic effects had beneficial effects only on cardiac innervations.

Topics: Adrenergic beta-1 Receptor Antagonists; Animals; Bisoprolol; Cardiovascular Agents; Disease Models, Animal; Heart; Heart Failure; Heart Rate; Hypertension; Ivabradine; Male; Myocardium; Norepinephrine; Parasympathetic Nervous System; Rats, Inbred Dahl; Sodium Chloride, Dietary; Sympathetic Nervous System; Tyrosine 3-Monooxygenase; Ventricular Function, Left

A multidisciplinary international working subgroup of the third Perioperative Quality Initiative consensus meeting appraised the evidence on the influence of preoperative arterial blood pressure and community cardiovascular medications on perioperative risk.. A modified Delphi technique was used, evaluating papers published in MEDLINE on associations between preoperative numerical arterial pressure values or cardiovascular medications and perioperative outcomes. The strength of the recommendations was graded by National Institute for Health and Care Excellence guidelines.. Significant heterogeneity in study design, including arterial pressure measures and perioperative outcomes, hampered the comparison of studies. Nonetheless, consensus recommendations were that (i) preoperative arterial pressure measures may be used to define targets for perioperative management; (ii) elective surgery should not be cancelled based solely upon a preoperative arterial pressure value; (iii) there is insufficient evidence to support lowering arterial pressure in the immediate preoperative period to minimise perioperative risk; and (iv) there is insufficient evidence that any one measure of arterial pressure (systolic, diastolic, mean, or pulse) is better than any other for risk prediction of adverse perioperative events.. Future research should define which preoperative arterial pressure values best correlate with adverse outcomes, and whether modifying arterial pressure in the preoperative setting will change the perioperative morbidity or mortality. Additional research should define optimum strategies for continuation or discontinuation of preoperative cardiovascular medications.

Topics: Blood Pressure; Cardiovascular Agents; Contraindications, Procedure; Delphi Technique; Elective Surgical Procedures; Humans; Hypertension; Perioperative Care; Postoperative Complications; Preoperative Period; Prognosis; Risk Assessment

With recent changes in the United Kingdom's clinical practice for diabetes mellitus care, contemporary estimates of sex disparities in cardiovascular risk and risk factor management are needed.. In this retrospective cohort study, using the Clinical Practice Research Datalink linked to hospital and death records for people in England, we identified 79 985 patients with incident type 2 diabetes mellitus (T2DM) between 2006 to 2013 matched to 386 547 patients without diabetes mellitus. Sex-stratified Cox models were used to assess cardiovascular risk.. Compared with women without T2DM, women with T2DM had a higher cardiovascular event risk (adjusted hazard ratio, 1.20 [95% confidence interval, 1.12-1.28]) with similar corresponding data in men (hazard ratio, 1.12 [1.06-1.19]), leading to a nonsignificant higher relative risk in women (risk ratio, 1.07 [0.98-1.17]). However, some important sex differences in the management of risk factors were observed. Compared with men with T2DM, women with T2DM were more likely to be obese, hypertensive, and have hypercholesterolemia, but were less likely to be prescribed lipid-lowering medication and angiotensin-converting enzyme inhibitors, especially if they had cardiovascular disease.. Compared with men developing T2DM, women with T2DM do not have a significantly higher relative increase in cardiovascular risk, but ongoing sex disparities in prescribing should prompt heightened efforts to improve the standard and equity of diabetes mellitus care in women and men.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Cardiovascular Agents; Cardiovascular Diseases; Diabetes Mellitus, Type 2; England; Female; Health Status Disparities; Healthcare Disparities; Humans; Hypercholesterolemia; Hypertension; Hypoglycemic Agents; Hypolipidemic Agents; Male; Middle Aged; Obesity; Primary Health Care; Retrospective Studies; Risk Assessment; Risk Factors; Sex Factors

Our patient therapeutic education program yields improvements in health after one year. But what can we see after 4 years, when the patient alone is responsible for following the program?. Two hundred and ninety-one patients participated in the first part of our study and were followed during one year. Four years into the ongoing study, we reviewed the progress of the first 200 patients. We compared the already published Risk Factors and Eating Habits scores between the beginning of the study (T0), one year later (T1) and after 4 years (T4).. The Risk Factor score at T0 is 9.5±7.8, moving to 7±7.5 at T1, and then to 6.8±7.8 at T4 (P<0.001 between T0 and T1 and T0 and T4). Endurance physical activities saw the greatest improvement: 0.79±5 at T0, -1.07±4.5 at T1 and -1.61±4.5 at T4 (P<0.001 between T0 and T1 and T0 and T4). The Eating Habits score went from -18.2±7.3 to -22.2±6.4 and then to -23.5±6.4 (P<0.001 between T0 and T1 and T0 and T4). The best results were obtained through increased consumption of whole grains, green vegetables and fish.. The positive results of the progress of risk factors and eating habits, noted after one year, are even greater four years after the end of the therapeutic education program.

Topics: Adult; Aged; Antihypertensive Agents; Body Mass Index; Cardiovascular Agents; Cardiovascular Diseases; Diabetes Complications; Feeding Behavior; Female; France; Health Knowledge, Attitudes, Practice; Humans; Hypercholesterolemia; Hypertension; Male; Middle Aged; Patient Education as Topic; Primary Prevention; Risk Factors; Smoking; Time Factors

The impact of atrial fibrillation (AF) on the prognosis of heart failure with preserved ejection fraction (HFpEF) is still the subject of debate. We analysed the influence of AF on the prognosis on mortality and readmission in patients with HFpEF.. Prospective observational study in 1,971 patients with HFpEF, who were admitted for acute heart failure. Patients were divided into 2 groups according to the presence or absence of AF. We analysed mortality, readmissions and combined mortality/readmissions at one year follow-up.. A total of 1,177 (59%) patients had AF, mean age 80.3 (7.8) years and 1,233 (63%) were women. Patients with HFpEF and AF were older, female, greater valvular aetiology and lower comorbidity measured by the Charlson index. At the one year follow-up, 430 (22%) patients had died and 840 (43%) had been readmitted. In the 2 groups analysed, there was no difference in all-cause mortality (22 vs. 21%; P=.739, AF vs. no-AF, respectively) or cardiovascular causes (9.6 vs. 8.2%; P=.739, AF vs. no-AF, respectively). In the multivariable analysis, factors associated with higher mortality were: age, male, valvular aetiology, uric acid, and comorbidity. In the analysis of the subgroup with HFpEF with AF, the presence of chronic AF compared to de novo AF was associated with higher mortality (HR 1,716; 95% CI 1,099-2,681; P=.018).. In patients with HFpEF, the presence of AF is frequent. During the one-year follow-up, the presence of AF does not influence mortality or readmissions in patients with HFpEF.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Cardiovascular Agents; Cause of Death; Comorbidity; Female; Heart Failure; Heart Valve Diseases; Humans; Hypertension; Male; Myocardial Ischemia; Patient Readmission; Prospective Studies; Stroke Volume

Left ventricular (LV) dysfunction develops during LV hypertrophy and particularly during tachycardia. Thus we investigated the effects of heart rate (HR) reduction with ivabradine, an I. Eight chronically instrumented pigs receiving continuous angiotensin II infusion during 28days to induce chronic hypertension and LV hypertrophy. Measurements were performed at Days 0 and 28 after stopping angiotensin II infusion in the presence and absence of ivabradine.. At Day 0, reducing HR from 75±3 to 55±2beats/min with ivabradine did not affect LV twist but slowed LV untwist along with an increase in LV end-diastolic pressure. At Day 28, LV posterior and septal wall thickness as well as the estimated LV mass increased, indicating LV hypertrophy. LV twist and untwist were significantly reduced by 33±4% from 16±1° and 32±6% from -154±9°/s, respectively, showing global LV systolic and diastolic dysfunction. In this context, ivabradine decreased HR by 25% from 86±5beats/min and significantly improved LV twist from 11±1 to 14±1° and LV untwist from -104±8 to -146±5°/s.. Administration of ivabradine during chronic hypertension and LV hypertrophy improved LV twist and untwist. This further supports the beneficial effect of this drug on both LV systolic and diastolic function during the development of LV hypertrophy.

Topics: Animals; Benzazepines; Cardiovascular Agents; Chronic Disease; Female; Hypertension; Hypertrophy, Left Ventricular; Ivabradine; Swine; Ventricular Dysfunction, Left

The aims of the present study were, firstly, to evaluate long-term trends in the occurrence and treatment of cardiovascular disease (CVD) risk factors and the occurrence of CVD events in children with type 1 diabetes mellitus (T1DM) and, secondly, to assess the determinants of undertreatment of CVD risk factors.. A retrospective cohort study was conducted in 3728 children (<19 years of age) with T1DM and up to 5 age- and gender-matched diabetes-free children (reference cohort) (n = 18 513) using data from the Clinical Practice Research Datalink (CPRD).. Compared with diabetes-free subjects, children with T1DM had significantly higher annual prevalence rates of CVD risk factors and cardiovascular (CV) medication use 20 years after the onset of diabetes (index date): hypertension: 35.2% vs. 11.4%, P < 0.001; hypercholesterolaemia: 66.7% vs. 7.14%, P < 0.001; and CV medication use: 37.0% vs. 3.6%, P < 0.001. The significant differences between prevalence rates in the two cohorts started from 1 year before the index date. Furthermore, 50% of the children in the T1DM cohort with hypertension and 53% with hypercholesterolaemia remained untreated with CV drugs for a period of 2-5 years during the 20-year follow-up. Age was the only determinant associated with undertreated hypertension in the T1DM cohort.. Children with T1DM had substantially higher prevalence rates of hypertension and hypercholesterolaemia from 1 year before up to 20 years after the onset of diabetes compared with nondiabetics. There is a substantial undertreatment of CVD risk factors with CV drugs. In children with T1DM, screening for CVD risk factors and adequate treatment are of the utmost importance to prevent CVD later in life.

Topics: Adolescent; Age Factors; Cardiovascular Agents; Cardiovascular Diseases; Case-Control Studies; Child; Child, Preschool; Cohort Studies; Diabetes Mellitus, Type 1; Female; Follow-Up Studies; Humans; Hypercholesterolemia; Hypertension; Infant; Male; Prevalence; Retrospective Studies; Risk Factors; Young Adult

Topics: Antihypertensive Agents; Blood Pressure; Cardiovascular Agents; Humans; Hypertension; Treatment Outcome

Medication synchronization programs based in pharmacies simplify the refill process by enabling patients to pick up all of their medications on a single visit. This can be especially important for improving medication adherence in patients with complex chronic diseases. We evaluated the impact of two synchronization programs on adherence, cardiovascular events, and resource use among Medicare beneficiaries treated between 2011 and 2014 for two or more chronic conditions-at least one of which was hypertension, hyperlipidemia, or diabetes. Among nearly 23,000 patients matched by propensity score, the mean proportion of days covered (a measure of medication adherence) for the control group of patients without a synchronization program was 0.84 compared to 0.87 for synchronized patients-a gain of 3 percentage points. Adherence improvement in synchronized versus control patients was three times greater in patients with low baseline adherence, compared to those with higher baseline adherence. Rates of hospitalization and emergency department visits and rates of outpatient visits were 9 percent and 3 percent lower in the synchronized group compared to the control group, respectively, while cardiovascular event rates were similar. Synchronization programs were associated with improved adherence for patients with cardiovascular disease, especially those with low baseline adherence.

Topics: Aged; Cardiovascular Agents; Community Pharmacy Services; Diabetes Mellitus; Drug Prescriptions; Female; Humans; Hypertension; Male; Medicare; Medication Adherence; Medication Therapy Management; Patient Acceptance of Health Care; Retrospective Studies; United States

Ginkgo biloba leaves extract has been widely used worldwide to protect against oxidative stress-induced cell damage and improves blood circulation.. The potential protective role of the standardized leaf extract of Ginkgo biloba (EGb761) on hypertension-induced renal injury was investigated in rats. Hypertension was induced in rats by L-NAME.. Repeated treatment with EGb761 produced progressive reductions in the systolic, diastolic and mean arterial blood pressure. Also, EGb761 increased the progressive reductions in blood pressure induced by losartan. Hypertension-induced marked elevation of renal malondialdehyde (MDA) and nitrite levels and reduction of reduced glutathione (GSH) level were inhibited by EGb761. In addition, hypertension-induced increases in tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and interleukin-1β (IL-1β)) levels in renal tissues were inhibited by EGb761. Also, treatment with EGb761 inhibited hypertension-induced decrease in endothelial nitric oxide synthase (eNOS) protein expression and increase in the protein expressions of inducible NO synthase (iNOS), TNF-α, IL-6 and IL-1B in the kidney tissues. EGb761 enhanced losartan effects on renal tissues oxidative stress, nitrite, and inflammatory markers levels and on protein expressions of eNOS, iNOS, TNF-α, IL-6 and IL-1B. effects.. These results indicate that EGb761 has the ability to protect against hypertension-induced renal injury.

Topics: Animals; Antihypertensive Agents; Arterial Pressure; Cardiovascular Agents; Ginkgo biloba; Glutathione; Hypertension; Hypertension, Renal; Interleukin-1beta; Interleukin-6; Kidney; Kidney Diseases; Losartan; Male; Malondialdehyde; NG-Nitroarginine Methyl Ester; Nitric Oxide Synthase Type II; Nitric Oxide Synthase Type III; Oxidative Stress; Plant Extracts; Rats; Tumor Necrosis Factor-alpha

Topics: Amlodipine; Antidepressive Agents; Antihypertensive Agents; Bradycardia; Cardiovascular Agents; Drug Therapy, Combination; Female; Humans; Hypertension; Hypoglycemic Agents; Middle Aged

Atrial fibrillation (AF) and dementia are predominant among the elderly; patients with AF have an increased dementia risk. We aimed to study if prescribed antihypertensive drugs and cardiovascular pharmacotherapies are associated with a lower relative risk of dementia.. All included patients were ≥45 years and diagnosed with AF in primary care; 12,096 (6580 men and 5516 women) in Sweden. We excluded patients with a dementia diagnosis before onset of AF. Cox regression was used (hazard ratios, HRs, and 95% confidence interval, CI) with adjustments for sex, age, socioeconomic factors and co-morbidities.. Incident dementia occurred in 750 patients (6.2%) during an average of 5.6 years of follow-up (a total of 69,214 person-years). Patients prescribed thiazides HR 0.81 (95% CI 0.66-0.99) and warfarin HR 0.78 (95% CI 0.66-0.92) had a lower risk of dementia than patients without these drugs. The use of 1-4 of the different antihypertensive drug classes (thiazides, beta blocker, vessel active calcium channel blockers or renin angiotensin aldosterone (RAAS) blockers) were associated with a reduction of incident dementia; HR 0.80 (95% CI 0.64-1.00) for one to two drugs, and HR 0.63 (95% CI 0.46-0.84) for three or four drugs, versus having no prescribed antihypertensive drugs. The combination of a RAAS-blocker and a thiazide was significant, HR 0.70 (95% CI 0.53-0.92), versus not having that particular combination prescribed, while RAAS-blockers or thiazides separately were not significant.. Prescribed antihypertensive drugs, including thiazide/RAAS-blocker combination therapy and use of warfarin, were associated with a decreased incidence of dementia.

Topics: Aged; Aged, 80 and over; Antihypertensive Agents; Atrial Fibrillation; Cardiovascular Agents; Dementia; Female; Follow-Up Studies; Humans; Hypertension; Incidence; Male; Middle Aged; Risk Factors; Sweden; Thiazides; Warfarin

Fibroblast growth factor 21 (FGF21) is a hormone secreted by the liver in response to metabolic stress. In addition to its well-characterized effects on energy homeostasis, FGF21 has been shown to increase water intake in animals. In this study, we sought to further explore the effects of FGF21 on fluid homeostasis in rats. A single dose of a long-acting FGF21 analog, PF-05231023, significantly increased water consumption, which was accompanied by an elevation in urine output that appeared prior to a significant change in water intake. We observed that FGF21 rapidly and significantly increased heart rate and blood pressure in telemeter-implanted rats, before changes in urine output and water intake were observed. Our data suggest that sympathetic activation may contribute to the pathogenesis by which FGF21 increases blood pressure as the baroreceptor unloading induced reflex tachycardia was significantly elevated in FGF21-treated animals. However, FGF21 was still capable of causing hypertension in animals in which approximately 40% of the sympathetic post-ganglionic neurons were ablated. Our data suggest that FGF21-induced water intake is in fact secondary to diuresis, which we propose to be a compensatory mechanism engaged to alleviate the acute hypertension caused by FGF21.

Topics: Animals; Antibodies, Monoclonal, Humanized; Baroreflex; Blood Pressure; Cardiovascular Agents; Delayed-Action Preparations; Diuresis; Diuretics; Drinking; Drinking Water; Electrolytes; Fibroblast Growth Factors; Guanethidine; Heart Rate; Hypertension; Kidney; Male; Rats, Wistar

High deductible health plans (HDHP) are associated with high levels of patient cost-sharing and are becoming increasingly used in the United Status as a means of reducing healthcare utilization and spending. Our objective is to determine whether HDHP enrollment is associated with a change in adherence to evidence-based medications to treat cardiovascular risk factors and whether such changes vary based on race/ethnicity or socioeconomic status.. We conducted a retrospective cohort study using an interrupted time series with concurrent control group design among beneficiaries of Aetna-a national commercial insurer. We included 14 866 patients who filled prescriptions for medications to treat hypertension, high cholesterol, or diabetes mellitus between 2009 and 2014 and who switched from a traditional plan into an HDHP and 14 866 controls who did not switch to an HDHP matched based on calendar time, medication class, race/ethnicity, socioeconomic status, and propensity score. We were specifically interested in evaluating 4 prespecified subgroups based on race/ethnicity (white versus nonwhite) and socioeconomic status (higher versus lower). The main outcome was medication adherence as measured by proportion of days covered. The overall cohort had an average age of 53 years, and 44% were women. Baseline adherence was the lowest in the nonwhite patient group. Switching to an HDHP was associated with a decrease in the level of adherence of 5 percentage points across all 4 subgroups (change in level, -5.0%; 95% CI, -5.9% to -4.0%; P<0.0001).. HDHP enrollment was associated with a reduction in adherence to medications to treat cardiovascular risk factors. The magnitude of this effect did not vary based on race/ethnicity or socioeconomic status. Because racial/ethnic minorities have lower rates of medication adherence, future studies should evaluate whether HDHP-associated changes in adherence have greater clinical consequences for these patients.

Topics: Adult; Cardiovascular Agents; Cohort Studies; Deductibles and Coinsurance; Diabetes Mellitus; Ethnicity; Evidence-Based Practice; Female; Humans; Hypertension; Male; Medication Adherence; Middle Aged; Patient Acceptance of Health Care; Retrospective Studies; Risk; Social Class; United States

Increased sympathetic nerve activity and the activation of the central renin-angiotensin system are commonly associated with cardiovascular disease states such as hypertension and heart failure, yet the precise mechanisms contributing to the long-term maintenance of this sympatho-excitation are incompletely understood. Due to the established physiological role of neurotrophins contributing toward neuroplasticity and neuronal excitability along with recent evidence linking the renin-angiotensin system and brain-derived neurotrophic factor (BDNF) along with its receptor (TrkB), it is likely the two systems interact to promote sympatho-excitation during cardiovascular disease. However, this interaction has not yet been fully demonstrated, in vivo. Thus, we hypothesized that central angiotensin II (Ang II) treatment will evoke a sympatho-excitatory state mediated through the actions of BDNF/TrkB. We infused Ang II (20ng/min) into the right lateral ventricle of male Sprague-Dawley rats for twelve days with or without the TrkB receptor antagonist, ANA-12 (50ng/h). We found that ICV infusion of Ang II increased mean arterial pressure (+40.4mmHg), increased renal sympathetic nerve activity (+19.4% max activity), and induced baroreflex dysfunction relative to vehicle. Co-infusion of ANA-12 attenuated the increase in blood pressure (-20.6mmHg) and prevented the increase in renal sympathetic nerve activity (-22.2% max) and baroreflex dysfunction relative to Ang II alone. Ang II increased thirst and decreased food consumption, and Ang II+ANA-12 augmented the thirst response while attenuating the decrease in food consumption. We conclude that TrkB signaling is a mediator of the long-term blood pressure and sympathetic nerve activity responses to central Ang II activity. These findings demonstrate the involvement of neurotrophins such as BDNF in promoting Ang II-induced autonomic dysfunction and further implicate TrkB signaling in modulating presympathetic autonomic neurons during cardiovascular disease.

Topics: Angiotensin II; Animals; Azepines; Baroreflex; Benzamides; Blood Pressure; Body Weight; Cardiovascular Agents; Defecation; Drinking; Heart Rate; Hypertension; Kidney; Male; Organ Size; Rats, Sprague-Dawley; Receptor, trkB; Sympathetic Nervous System; Urination

This study aimed to assess the prevalence, the change, and the determinants of change in polypharmacy in a population-based sample.. Baseline (2003-2006) and follow-up (2009-2012) data are from 4679 participants aged between 35 and 75 years (53.5% women, mean age 52.6 ± 10.6 years) from the population of Lausanne, Switzerland. Polypharmacy was defined by the regular use of ≥5 drugs. Four categories of change were defined: never (no polypharmacy at baseline and follow-up), initiating (no polypharmacy at baseline but at follow-up), maintaining, or quitting.. Polypharmacy increased from 7.7% at baseline to 15.3% at follow-up. Cardiovascular drugs were the most prescribed medicines at baseline and follow-up. Gender, age, obesity, smoking, previously diagnosed hypertension, or diabetes or dyslipidemia were significantly and independently associated with initiating and maintaining polypharmacy.. In a population-based sample, prevalence of polypharmacy doubled over a 5.6-year period. The main determinants of initiating polypharmacy were age, overweight and obesity, smoking status, and previously diagnosed cardiovascular risk factors.

Topics: Adult; Aged; Analgesics; Cardiovascular Agents; Diabetes Mellitus; Dyslipidemias; Female; Humans; Hypertension; Hypoglycemic Agents; Life Style; Male; Middle Aged; Overweight; Polypharmacy; Prevalence; Psychotropic Drugs; Risk Factors; Smoking; Switzerland

Using a TV device to study brain microcirculation, we found that after a course of vascular peptide bioregulator the density of microvascular network of pia matter of old hypertensive rats (12 months) sensomotor cortex increased about 1,7 times compared to intact old rates SHR. This perfusion in the tissue of the cerebral cortex and the degree of blood oxygen saturation in the microvasculature of this tissue region raised.. С помощью телевизионной установки для прижизненного исследования микроциркуляции в головном мозге выявлено, что после курсового применения пептидного биорегулятора сосудов у спонтанно гипертензивных крыc в возрасте 12 мес линии SHR увеличивалась (примерно в 1,7 раза) плотность микрососудистой сети пиальной оболочки и достоверно возрастали уровень перфузии и сатурации кислородом в ткани коры головного мозга по сравнению с показателями у интактных животных SHR той же возрастной категории.

Topics: Animals; Cardiovascular Agents; Cerebral Cortex; Cerebrovascular Circulation; Hypertension; Microcirculation; Peptides; Pia Mater; Rats; Rats, Inbred SHR; Rats, Inbred WKY

Chronic obstructive pulmonary disease (COPD) is commonly associated with multiple comorbidities. Our objective was to assess the prevalence of comorbidities in patients with COPD and to relate their prevalence to the severity of the disease by using a large German health care database. Based on the retrospective analysis of a two-year (2013-2014) database from the German Statutory Health Insurance system, we obtained a representative sample of 4,075,493 german insurants. This sample included 146,141 patients with COPD (age: ≥35 years). To these patients, we matched 1:1 by age and gender randomly selected non-COPD controls. We assessed the comorbidities and the use of cardiovascular drugs, and examined COPD subgroups according to lung function (ICD-10-coded FEV1) and the treatment with long-acting inhaled bronchodilators. Compared to non-COPD, patients with COPD had a higher prevalence of hypertension, congestive heart failure, diabetes, gastroesophageal reflux disease, chronic kidney disease, osteoporosis, psychiatric disease and lung cancer, and used more cardiovascular-related drugs. However, the prevalence of comorbidities did not correlate to the severity of airflow limitation. The results of this sizeable nationwide survey support the concept that individuals with COPD need careful evaluation regarding comorbidities. This can already be of relevance in patients with mild to moderate airflow limitation.. Comorbidities in COPD have a complex relationship with disease severity, requiring a comprehensive therapy approach.

Topics: Aged; Bronchodilator Agents; Cardiovascular Agents; Cardiovascular Diseases; Comorbidity; Diabetes Mellitus; Female; Forced Expiratory Volume; Gastroesophageal Reflux; Germany; Heart Failure; Humans; Hypertension; Lung Neoplasms; Male; Middle Aged; Osteoporosis; Prevalence; Pulmonary Disease, Chronic Obstructive; Renal Insufficiency, Chronic; Retrospective Studies; Severity of Illness Index

Human Albumin is a unique pleiotropic protein with multiple properties. Previous clinical and laboratory studies have indicated a possible beneficial effect of Albumin in subarachnoid hemorrhage (SAH). The present study aimed to further define the preclinical characteristics of Albumin. SAH was induced by endovascular perforation in Sprague-Dawley rats. In the dose-escalation study, Albumin ranging from 0.02g/kg to 1.0g/kg was intravenously infused immediately after SAH. In the therapeutic window study, 1.0g/kg Albumin was administered at 0h, 2h, 4h or 8h after SAH. Physiologic variables were monitored in different Albumin treatment regimens. One day after SAH, neurological scores, SAH scores, blood-brain barrier permeability, neural degeneration and apoptosis were examined. The efficacy of Albumin for SAH was also determined in female rats and in spontaneously hypertensive rats. We found that 0.2g/kg and 1.0g/kg Albumin significantly attenuated sensorimotor deficits, brain edema, IgG leakage, and neuronal degeneration after SAH. The benefits of Albumin existed even when the administration was delayed to 4h after SAH onset. No significant difference was found between 0.2g/kg and 1.0g/kg Albumin groups. In female rats and spontaneously hypertensive rats, Albumin likewise improved neurological outcomes and early brain injury. In conclusion, Albumin could reduce both cerebral lesions and functional deficits in the early stage of SAH. The beneficial regimen occurs within a favorable therapeutic window and is reproducible in different high-risk subjects.

Topics: Albumins; Animals; Brain; Cardiovascular Agents; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Evaluation, Preclinical; Female; Humans; Hypertension; Male; Neuroprotective Agents; Random Allocation; Rats, Inbred SHR; Rats, Sprague-Dawley; Severity of Illness Index; Subarachnoid Hemorrhage; Time Factors

The study aimed to investigate the protective effect of tanshinone IIA against cardiac hypertrophy in spontaneously hypertensive rats (SHRs) through the Cys-C/Wnt signaling pathway. Thirty SHRs were randomly divided into cardiac hypertrophy, low- and high-dose tanshinone IIA groups. Ten Wistar-Kyoto rats were selected as control group. The systolic blood pressure (SBP), heart weight (HW), left ventricular weight (LVW) and body weight (BW) of all rats were recorded. HE staining and qRT-PCR were applied to observe the morphology of myocardial tissue and mRNA expressions of COL1A1 and COL3A1. ELISA and Western blotting were used to measure the serum asymmetric dimethylarginine (ADMA), nitric oxide (NO) and cardiac troponin I (cTnI) levels, and the expressions of the Cys-C/Wnt signaling pathway-related proteins, eNOS and Nox4. Compared with the cardiac hypertrophy group, the SBP, HW/BW, LVW/BW, swelling degree of myocardial cells, COL1A1 and COL3A1 mRNA expressions, serum cTnI and ADMA levels, and the Cys-C/Wnt signaling pathway-related proteins and Nox4 expressions in the low- and high-dose tanshinone IIA groups were decreased, but the endothelial NO synthase (eNOS), phosphorylated eNOS (Ser1177) and NO expressions were increased. No significant difference was found between the low- and high-dose tanshinone IIA groups. Our study indicated a protective effect of tanshinone IIA against cardiac hypertrophy in SHRs through inhibiting the Cys-C/Wnt signaling pathway.

Topics: Abietanes; Animals; Arginine; Cardiomegaly; Cardiovascular Agents; Collagen Type I; Collagen Type I, alpha 1 Chain; Collagen Type III; Cystatin C; Disease Models, Animal; Hypertension; Male; Myocardium; NADPH Oxidase 4; Nitric Oxide; Nitric Oxide Synthase Type III; Phosphorylation; Rats, Inbred SHR; Rats, Inbred WKY; Time Factors; Troponin I; Wnt Signaling Pathway

While secondary prevention improves prognosis after acute myocardial infarction (AMI), previous studies have suggested suboptimal guideline adherence, lack of improvement over time and gender differences. This study contributes contemporary data from a large national cohort.. We identified 51,620 patients <75 years examined at two and/or twelve months post AMI in the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART). Risk factor control and readmissions at one year were compared between the 2005 and 2012 cohorts, and between genders.. Lipid control (LDL-cholesterol <2.5 mmol/L) improved from 67.9% to 71.1% (p = 0.016) over time, achieved by 67.9% vs 63.3%, p < 0.001 of men vs women. Blood pressure control (<140 mmHg systolic) increased over time (59.1% vs 69.5%, p < 0.001 in 2005 and 2012 cohorts) and was better in men (66.4% vs 61.9%, p < 0.001). Smoking cessation rate was 55.6% without differences between genders or over time. Cardiac readmissions occurred in 18.2% of women and 15.5% of men, decreasing from 2005 to 2012 (20.8% vs 14.9%). Adjusted odds ratio was 1.22 (95% CI 1.14-1.32) for women vs men and 0.94 (95% CI 0.92-0.96) for the 2012 vs the 2005 cohort.. Although this study compares favourably to previous studies of risk factor control post AMI, improvement over time was mainly seen regarding blood pressure, revealing substantial remaining preventive potential. The reasons for gender differences seen in risk factor control and readmissions require further analysis.

Topics: Aged; Cardiovascular Agents; Cholesterol, LDL; Female; Guideline Adherence; Health Behavior; Humans; Hypertension; Male; Medication Adherence; Middle Aged; Myocardial Infarction; Patient Readmission; Practice Guidelines as Topic; Registries; Secondary Prevention; Sex Distribution; Sex Factors; Smoking Cessation; Sweden

Topics: Aged; Atrial Fibrillation; Cardiovascular Agents; Contraindications; Digoxin; Drug Substitution; Drug-Related Side Effects and Adverse Reactions; Electrocardiography; Female; Heart Failure, Diastolic; Humans; Hypertension; Renal Insufficiency, Chronic; Treatment Outcome; Withholding Treatment

The aim of this study was to assess the feasibility and preliminary outcomes of a medication self-management platform for chronically ill patients, Medplan.. We performed a 6-month single-arm prospective pre-post intervention study of patients receiving treatment for hypertension and/or dyslipidemia and/or heart failure and/or human immunodeficiency virus infection. During the pre-intervention phase, participants were followed according to their usual care; during the intervention phase, they used Medplan. We evaluated adherence, health outcomes, healthcare resources and measured the satisfaction of patients and health care professionals.. The study population comprised 42 patients. No differences were found in adherence to medication measured by proportion of days covered with medication (PDC). However, when adherence was measured using the SMAQ, the percentage of adherent patients improved during the intervention phase (p < 0.05), and the number of days with missed doses decreased (p < 0.05). Adherence measured using the Medplan app showed poor concordance with PDC. No differences were found in health outcomes or in the use of health care resources during the study period. The mean satisfaction score for Medplan was 7.2 ± 2.7 out of 10 among patients and 7.3 ± 1.7 among health care professionals. In fact, 71.4 % of participants said they would recommend the app to a friend, and 88.1 % wanted to continue using it.. The Medplan platform proved to be feasible and was well accepted by its users. However, its impact on adherence differed depending on the assessment method. The lack of effect on PDC is mainly because patients were already good adherers at baseline. The study enabled us to validate the platform in real patients using many different mobile devices and to identify potential barriers to scaling up the platform.

Topics: Adult; Aged; Anti-Retroviral Agents; Cardiovascular Agents; Cardiovascular Diseases; Chronic Disease; Dyslipidemias; Female; Heart Failure; HIV Infections; Humans; Hypertension; Internet; Male; Medication Adherence; Middle Aged; Mobile Applications; Patient Satisfaction; Prospective Studies; Self Care; Smartphone

Chronic hypertension is associated with left ventricular (LV) hypertrophy and LV diastolic dysfunction with impaired isovolumic relaxation and abnormal LV filling. Increased heart rate (HR) worsens these alterations. We investigated whether the I f channel blocker ivabradine exerts beneficial effects on LV filling dynamic. In this setting, we also evaluated the relationship between LV filling and isovolumic contraction as a consequence of contraction-relaxation coupling. Therefore, hypertension was induced by a continuous infusion of angiotensin II during 28 days in 10 chronically instrumented pigs. LV function was investigated after stopping angiotensin II infusion to offset the changes in loading conditions. In the normal heart, LV relaxation filling, LV early filling, LV peak early filling rate were positively correlated to HR. In contrast, these parameters were significantly reduced at day 28 vs. day 0 (18, 42, and 26 %, respectively) despite the increase in HR (108 ± 6 beats/min vs. 73 ± 2 beats/min, respectively). These abnormalities were corrected by acute administration of ivabradine (1 mg/kg, iv). Ivabradine still exerted these effects when HR was controlled at 150 beats/min by atrial pacing. Interestingly, LV relaxation filling, LV early filling and LV peak early filling were strongly correlated with both isovolumic contraction and relaxation. In conclusion, ivabradine improves LV filling during chronic hypertension. The mechanism involves LV contraction-relaxation coupling through normalization of isovolumic contraction and relaxation as well as HR-independent mechanisms.

Topics: Animals; Benzazepines; Cardiovascular Agents; Disease Models, Animal; Female; Hemodynamics; Hypertension; Ivabradine; Swine; Ventricular Function, Left

Topics: Cardiovascular Agents; Child; Humans; Hypertension

To investigate the effects of chronic administration of ranolazine (RAN) on experimental model of heart failure with preserved ejection fraction.. Seven-weeks old Dahl salt-sensitive rats were fed a high salt diet for 5weeks to induce hypertension. Afterwards, rats continued with a high salt diet and were administered either with vehicle or RAN (20mg/kg/die, ip) for the following 8weeks. Control rats were maintained on a low salt diet.. While systolic parameters were not altered, diastolic parameters were changed in high salt animals. Hemodynamic analysis showed a decreased dP/dt min, increased LVEDP, longer time constant and steeper slope of the end-diastolic pressure-volume relationship. Treatment with RAN attenuated these alterations and determined a reduction in mortality. Additionally, the magnitude of myocardial hypertrophy and activation of PI3K/Akt pathway were reduced. Alteration in diastolic compliance as a consequence of elevated myocardial stiffness was confirmed by an increase of collagen deposition and activation of pro-fibrotic TGF-β/SMAD3/CTGF signaling. These effects were counteracted by RAN. High salt rats had a decrease in SERCA2 and an increase in Na(+)/Ca(2+) exchanger (NCX). Treatment with RAN reduced NCX expression and determined an increment of SERCA2. Moreover, the levels of nitrotyrosine and oxidized dyhydroethidium were higher in high salt rats. RAN induced a decrement of oxidative stress, supporting the concept that reduction in ROS may mediate beneficial effects.. Our findings support the possibility that diastolic dysfunction can be attenuated by RAN, indicating its ability to affect active relaxation and passive diastolic compliance.

Topics: Animals; Cardiovascular Agents; Disease Models, Animal; Drug Administration Schedule; Heart Failure; Humans; Hypertension; Male; Phosphatidylinositol 3-Kinases; Proto-Oncogene Proteins c-akt; Ranolazine; Rats; Rats, Inbred Dahl; Signal Transduction; Stroke Volume; Treatment Outcome; Ventricular Remodeling

Central hydrogen sulfide (H2S) has been reported to act as a gaseous neuromodulator involved in the ventilatory and cardiovascular control of normotensive rats, whereas no information is available in spontaneously hypertensive rats (SHR). We recorded minute ventilation (VE), mean arterial pressure (MAP) and heart rate (HR) before and after blocking of enzyme Cystathionine β-synthase (CBS) producing H2S in neural tissue by microinjection of aminooxyacetate (inhibitor of CBS) into the fourth ventricle of Wistar normotensive rats (WNR) and SHR followed by 30min of normoxia (21% inspired O2) or hypoxia (10% inspired O2) exposure. Microinjection of AOA or saline (1μL) did not change VE, MAP and HR during normoxia in both WNR and SHR. In WNR, hypoxia caused an increase in VE, HR and a decrease in MAP and these responses were unaltered by AOA. In SHR, hypoxia produced a higher increase of VE, and decrease in MAP and HR when compared to WNR, and these responses were all blunted by AOA. In conclusion, endogenous H2S plays important modulatory roles on hypoxia-induced ventilatory and cardiovascular responses, inhibiting the cardiovascular and stimulating the respiratory systems in SHR.

Topics: Animals; Arterial Pressure; Cardiovascular Agents; Cardiovascular System; Disease Models, Animal; Fourth Ventricle; Heart Rate; Hydrogen Sulfide; Hypertension; Hypoxia; Male; Rats, Inbred SHR; Rats, Wistar; Respiration; Tidal Volume

The HOPE-3-Trial investigated the effect of primary prevention on cardio- and neurovascular events in patients without known atherosclerotic disease, but with intermediate risk. In a factorial design Rosuvastatin 10 mg, Candesartan 16 mg/HCT 12.5 mg or both were compared with placebo. Rosuvastatin effectively lowered LDL-cholesterol and the rate of cardio- and neurovascular complications with a NNT of approximately 500/year without detectable effect on mortalitiy. Candesartan 16 mg/HCT 12.5 mg did not influence any endpoint, however, the predefined subgroup of patients with hypertension level I had a benefit. Patients with systolic pressure <131 mmHg even trended towards a higher risk if treated. The combination of statin and blood pressure-lowering agents showed no additive effects. The benefit was solely the result of statin therapy alone. Primary prevention with Rosuvastatin can be recommended if the cardio- and neurovascular risk is 1-2%/year, independent of the initial LDL, although the NNT of 500-1400/year is high and mortalitiy is not decreased. Possibly there will be future studies with longer term follow up to verify a reduction in mortality. Therapy with Candesartan 16 mg/HCT 12,5 mg has a beneficial effect only in patients with hypertension. Further studies with different antihypertensives and more intensive blood pressure lowering are desirable. The approach of combining all three drugs within a poly-pill for primary prevention in an intermediate risk population without elevated blood pressure is not recommended.

Topics: Cardiovascular Agents; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypertension; Myocardial Infarction; Stroke

Bronchial asthma (BA) is a serious problem. It was found that the frequency of arterial hypertension (AH) detection in patients with asthma is about 30 %. At patients practically all types of violations of a warm rhythm meet a bronkhoobstruktivny syndrome. Emergence of rather new preparations - If-blockers, opens new opportunities in correction of heart rate (HR) and a cardioprotection at a combination of AH and BA.. To assess therapy diltiazem-retard and ivabradine on structurally functional changes of a cardiac muscle and HR at patients with AH in combination with BA.. Patients (n=91) with BA with AH 1, 2. All patients were outpatients and taken therapy on BA with inhaled corticosteroids. The patients used a 2-agonists. All patients were performed the echocardioscopy on Acuson 128XP/ 10c (USA). Holter monitor ECG (HM-EKG) was found myocardium ischemia - 18 patients, research was continued by 73 persons. The patients were divided into 2 groups. In the first group made n=37, age 53+/-7,64, received diltiazem-retard. The second group included n=36, age 51,2+/-7,13 years - ivabradine. Duration of observation is 12 weeks.. Therapy ivabradine and diltiazem at patients BA according to HM-EKG reliable decrease in frequency of registration of ventricular extrasistoliya in days and heart rate (HR) (<0,05), the quantity of supraventricular extrasistoliya per day doubtfully decreased. Diltiazem wasn't more effective concerning decrease in HR, ventricular and supraventricular extrasistoliya, when comparing with ivabradine (>0,05). The result of 12 week therapy ivabradine at patients with a combination of AH and BA more significant was observed in comparison with diltiazem, regression a hypertrophy of the left ventricle, improvement of diastolic function and almost full regression of warm ektopiya. The tendency was to decrease and stabilization arterial pressure and decrease in HR to purpose level.

Topics: Aged; Asthma; Benzazepines; Cardiovascular Agents; Electrocardiography; Electrocardiography, Ambulatory; Heart; Heart Rate; Humans; Hypertension; Ivabradine; Middle Aged

to elucidate significance of regulatory adaptive status (RAS) for assessment of effectiveness of medical treatment and prediction of cardiovascular complications in functional class (FC) III congestive heart failure (CHF).. We included into this study 100 patients with hypertensive disease (HD) or ischemic heart disease (IHD) and FC III CHF with compromised systolic left ventricular (LV) function. All patients were randomized into two groups. In addition to complex background therapy (quinapril, torasemide, spironolactone) patients of group 1 (n=56, age 57.5+/-21.7 years) were given metoprolol succinate (59.1+/-12.1 mg/day) and patients of group 2 (n=44, age 57.1+/-21.4 years) - ivabradine (12.1+/-4.6 mg/day). Examination at baseline and after 6 months included cardiorespiratory synchronism test (in order to quantitatively define RAS), echocardiography, treadmill test, six minute walk test. Cardiovascular complications (CVC) were registered during 12 months of study treatment.. Both schemes of complex therapy equally improved structural and functional state of the myocardium, increased tolerance to physical exercise, reduced neurohumoral hyperactivation. Positive impact on RAS was more pronounced in ivabradine group. Clinical efficacy of therapy as well as number of hospitalizations because of CHF decompensation, ischemic strokes, and cardiovascular deaths did not differ substantially between groups. Initially low or unsatisfactory RAS was associated with higher incidence of CVC while initial unsatisfactory RAS was associated with elevated risk of sudden death.. The data obtained reflect independent value of determination of RAS for assessment of efficacy of pharmacotherapy and prognosis of CVC in patients with FCIII CHF.

Topics: Aged; Benzazepines; Cardiovascular Agents; Chronic Disease; Echocardiography; Exercise Test; Female; Heart Failure; Humans; Hypertension; Ivabradine; Male; Metoprolol; Middle Aged; Quinapril; Random Allocation; Spironolactone; Tetrahydroisoquinolines; Treatment Outcome; Ventricular Function, Left

This registry study aimed to evaluate the effects of supplementation with pycnogenol on altered endothelial function (EF) in borderline hypertensive, hyperlipidemic and hyperglycemic subjects without atherosclerotic changes in their main arteries and no coronary artery disease.. Flow mediated dilatation (FMD) and endothelium-independent (EID) dilatation were measured with brachial ultrasound after occlusion. Also, after occlusion, laser Doppler (LDF) flux and distal straingauge flow were measured. Oxidative stress (oxstress) was evaluated at 8 and 12 weeks. 93 subjects with borderline symptoms were enrolled into the study: 32 hypertensives, 31 hyperlipidemics, 30 hyperglycemics. All participants were instructed to follow the best available management to control their symptoms. In addition to best management, half of the subjects in each group used 150 mg/day Pycnogenol(®). 31 normal subjects were included as control.. After 12 weeks metabolic values and blood pressure were back to normal in all subjects. Values were slightly better under Pycnogenol(®). FMD increased after 8 weeks from an average 5.3;3.4% to 8.2;2.2% with a further increase to 8.8;3.1% (P<0.05) at 12 weeks. No effects were found in controls and normal subjects. EID of normal subjects was consistently higher with 26%. LDF skin flux increased with Pycnogenol(®) at 8 weeks and 12 weeks. The final flux increase was not different from normal values. In controls flux after occlusion was not improved at 8 weeks; there was a significant but minor increase at 12 weeks. Flux increases were superior in all Pycnogenol(®) subjects. In Pycnogenol(®) subjects, limb flow after occlusion increased at 8 weeks with a further increase at 12 weeks. In controls inclusion flow after occlusion was comparable at 8 and 12 weeks. Oxidative stress was significantly decreased in Pycnogenol(®) subjects at 8 and 12 weeks. Minor differences were observed in controls.. This open registry study indicates that Pycnogenol(®) improves EF in preclinical, borderline subjects in a macro-microcirculatory model. This observation may suggest an important preventive possibility for borderline hypertensive, hyperglycemic and hyperlipidemic subjects.

Topics: Adult; Antioxidants; Biomarkers; Blood Flow Velocity; Blood Glucose; Blood Pressure; Brachial Artery; Cardiovascular Agents; Case-Control Studies; Endothelium, Vascular; Female; Flavonoids; Humans; Hyperglycemia; Hyperlipidemias; Hypertension; Laser-Doppler Flowmetry; Lipids; Male; Middle Aged; Oxidative Stress; Plant Extracts; Plethysmography; Predictive Value of Tests; Registries; Time Factors; Treatment Outcome; Ultrasonography; Vasodilation

Defibrillation testing (DT) is considered a standard procedure during implantable cardioverter-defibrillator (ICD) implantation. However, little is known about the factors that are significantly related to patients with high defibrillation threshold (DFT) using the present triad system.. We examined 286 consecutive patients who underwent ICD implantation with a transvenous dual-coil lead and DT from December 2000 to December 2011. We defined patients who required 25 J or more by the implanted device as the high DFT group, and those who required less than 25 J as the normal DFT group. For each patient, assessment parameters included underlying disease, comorbidities, NYHA functional class, drugs, and echocardiographic measures. The high DFT group consisted of 12 patients (4.2%). Multivariate analysis identified 3 independent predictors for high DFT: atrial fibrillation (odds ratio (OR) 4.85, 95% confidence interval (CI) 1.24-22.33, P=0.023), hypertension (OR 4.01, 95% CI 1.08-15.96, P=0.039), thickness of interventricular septum (IVS) >12 mm (OR 4.82, 95% CI 1.17-20.31, P=0.030).. Atrial fibrillation, hypertension and IVS hypertrophy were significantly associated with high DFT. Identification of such patients could help to lower the risk of complications with DT.

Topics: Atrial Fibrillation; Cardiovascular Agents; Combined Modality Therapy; Defibrillators, Implantable; Electrodes; Equipment Design; Female; Heart Diseases; Heart Septum; Humans; Hypertension; Hypertrophy; Male; Middle Aged; Retrospective Studies; Risk Factors; Ventricular Fibrillation

The difference between left atrial (LA) and systemic coagulation activity in paroxysmal atrial fibrillation (PAF) is unclear.. We enrolled 100 patients with PAF who underwent AF ablation. Warfarin was stopped 1 day before the procedure. LA volume index and LA emptying fraction were measured by 64-slice multidetector computed tomography. Immediately after transseptal puncture, blood samples were simultaneously collected from the LA and systemic circulation (SC). In addition, to evaluate the effect of warfarin on D-dimer levels we recruited an additional 27 PAF patients on continuous warfarin. Even in patients with low CHADS2 scores (mean 0.59 ± 0.68) and during sinus rhythm, the prevalence of positive LA-D-dimer (≥ 0.5 µg/ml) was greater than that of SC-D-dimer (23% vs. 10%, P<0.01). The LA-D-dimer-positive patients had a larger mean LA volume index and reduced LA emptying fraction than the LA-D-dimer-negative patients. Multiple logistic regression analysis revealed that LA volume index was independently correlated with positive LA-D-dimer (odds ratio 2.245, 95% confidence interval 1.194-4.626, P=0.0112). The prevalence of positive LA-D-dimer was significantly lower in patients taking continuous warfarin, than in those on discontinuous warfarin (3.7% vs. 23%, P=0.025).. An enlarged LA volume index was associated with high LA coagulation status in patients with paroxysmal AF. Adequate warfarin control during AF catheter ablation may reduce the prevalence of positive LA-D-dimer.

Topics: Adult; Aged; Anticoagulants; Atrial Fibrillation; Blood Coagulation; Cardiovascular Agents; Catheter Ablation; Combined Modality Therapy; Comorbidity; Diabetes Mellitus; Female; Fibrin Fibrinogen Degradation Products; Heart Atria; Humans; Hypertension; International Normalized Ratio; Male; Middle Aged; Multidetector Computed Tomography; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Prospective Studies; Prothrombin Time; Severity of Illness Index; Stroke; Thrombophilia; Thrombosis; Ultrasonography; Warfarin

Several reports have evaluated the association between seasonal variation and acute heart failure (AHF) onset. Cold weather may induce AHF, but the clinical characteristics of patients susceptible to AHF during winter have not been established. Clinical Scenario (CS) is used in the early clinical management of AHF, so we investigated the relationship between CS classification and winter onset of AHF in Japan.. We enrolled 582 patients hospitalized for AHF and compared the frequency of AHF among the 4 seasons in each CS group to clarify the clinical characteristics of the winter onset group. Significant increase of AHF during winter was seen in CS1 (systolic blood pressure [SBP] (>140 mmHg) (P=0.01) but not in CS2 (SBP ≥ 100 and ≤ 140 mmHg) or CS3 (SBP <100 mmHg). CS1 patients were divided into winter and other season admission groups. In multivariate analysis, only lack of loop diuretic use was associated with winter admission of CS1 patients (odds ratio 0.562, 95% confidence interval: 0.256-0.798, P=0.006).. Winter predominance of AHF was seen only in CS1, and lack of loop diuretic use was a risk factor for winter onset. Future studies are necessary to confirm whether loop diuretics are useful in preventing AHF with CS1 in winter.

Topics: Acute Disease; Aged; Aged, 80 and over; Cardiovascular Agents; Cold Temperature; Comorbidity; Disease Management; Disease Susceptibility; Drug Utilization; Female; Heart Failure; Humans; Hypertension; Japan; Kaplan-Meier Estimate; Male; Retrospective Studies; Risk Factors; Seasons; Sodium Potassium Chloride Symporter Inhibitors; Sympathetic Nervous System; Systole; Vasoconstriction

Few data exist on the recent trends in the outcome of women hospitalized with acute coronary syndrome. We examined temporal trends in the hospital management and outcomes of women hospitalized with acute coronary syndrome in a real-world setting.. We evaluated time-dependent changes in the clinical characteristics, management strategies, and outcomes of women enrolled in the Acute Coronary Syndrome Israeli Surveys (ACSIS) between 2000 and 2010. Periods were categorized as early (2000-2004) and late (2006-2010).. Among 11,536 patients enrolled in ACSIS, 2710 (24%) were women. Frequency of women presenting with acute coronary syndrome had declined from 25% in 2000 to 22% in 2010 (P for trend = .002). Women presented less frequently with ST-elevation myocardial infarction and more frequently with associated comorbidities (P < .001 for both). There was no significant reduction in the time delay from symptom onset to emergency department between early and late periods (median: 128 vs 125 minutes; P = .86). This was further reflected in no increase in the frequency of women meeting the goal of door-to-balloon time of ≤90 minutes. The utilization of evidence-based cardiovascular therapies had increased significantly over the past decade (P < .001 for all). After multivariate adjustment, admission in the late surveys was associated with a significant reduction in 30-day major adverse cardiac events and 1-year mortality (hazard ratio 0.76; 95% confidence interval, 0.65-0.9, and 0.73; 0.59-0.89, respectively).. Despite increased frequency of comorbidities and lack of change in time to admission among women hospitalized with acute coronary syndrome, temporal change in management strategies over the last decade may have contributed to improved outcomes in this population.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Cardiovascular Agents; Comorbidity; Coronary Care Units; Diabetes Mellitus; Disease Management; Female; Hospital Mortality; Humans; Hypertension; Israel; Middle Aged; Myocardial Infarction; Odds Ratio; Patient Admission; Registries; Time-to-Treatment; Treatment Outcome

Patients suffering from atrial fibrillation can be classified into different subtypes, according to the temporal pattern of the arrhythmia and its recurrence. Nowadays, clinicians cannot differentiate a priori between the different subtypes, and patient classification is done afterwards, when its clinical course is available. In this paper we present a comparison of classification performances when differentiating paroxysmal and persistent atrial fibrillation episodes by means of support vector machines. We analyze short surface electrocardiogram recordings by extracting modulus and phase features from several time-frequency transforms: short-time Fourier transform, Wigner-Ville, Choi-Williams, Stockwell transform, and general Fourier-family transform. Overall, accuracy higher than 81% is obtained when classifying phase information features of real test ECGs from a heterogeneous cohort of patients (in terms of progression of the arrhythmia and antiarrhythmic treatment) recorded in a tertiary center. Therefore, phase features can facilitate the clinicians' choice of the most appropriate treatment for each patient by means of a non-invasive technique (the surface ECG).

Topics: Adult; Aged; Aged, 80 and over; Area Under Curve; Atrial Fibrillation; Cardiovascular Agents; Cohort Studies; Electrocardiography; Fourier Analysis; Humans; Hypertension; Middle Aged; Principal Component Analysis; ROC Curve; Sensitivity and Specificity; Support Vector Machine; Tertiary Care Centers

Recent trends in the clinical characteristics, management and prognosis of dilated cardiomyopathy (DCM) remain to be examined in Japan.. We compared 306 and 710 DCM patients in the Chronic Heart Failure Analysis and Registry in the Tohoku District (CHART)-1 (2000-2005, n=1,278) and the CHART-2 (2006-present, n=10,219) Studies, respectively. Between the 2 groups of DCM patients, there were no significant differences in baseline characteristics. The prevalence of hypertension, dyslipidemia and diabetes mellitus were all significantly increased from the CHART-1 to the CHART-2 Study. The use of β-blockers and aldosterone antagonists was significantly increased, while that of loop diuretics and digitalis was significantly decreased in the CHART-2 Study. The 3-year mortality rate was significantly improved from 14% in the CHART-1 to 9% in the CHART-2 Study (adjusted HR, 0.60; 95% CI: 0.49-0.81; P=0.001). In particular, 3-year incidence of cardiovascular death was significantly decreased (adjusted HR, 0.26; 95% CI: 0.14-0.50, P<0.001), while that of HF admission was not (adjusted HR, 0.90; 95% CI: 0.59-1.37, P=0.632). The prognostic improvement was noted in patients with BNP <220 pg/ml, LVEF>40%, β-blocker use and aldosterone antagonist use.. Long-term prognosis of DCM patients has been improved, along with the implementation of evidence-based medication in Japan.

Topics: Adrenergic beta-Antagonists; Aged; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Cardiomyopathy, Dilated; Cardiovascular Agents; Cardiovascular Diseases; Cause of Death; Comorbidity; Diabetes Mellitus; Drug Utilization; Dyslipidemias; Evidence-Based Medicine; Female; Follow-Up Studies; Humans; Hypertension; Incidence; Japan; Life Style; Male; Middle Aged; Mineralocorticoid Receptor Antagonists; Prognosis; Proportional Hazards Models; Prospective Studies; Registries; Sodium Potassium Chloride Symporter Inhibitors; Treatment Outcome

Heart failure (HF) is one of the most debilitating chronic illnesses. The prevalence is expected to increase due to aging population. The current study aimed to examine the management of heart failure with preserved ejection fraction (HFpEF) including drug use pattern, direct medical cost and humanistic outcome in a local public hospital in Hong Kong.. The current study adopted the retrospective observational study design. Subjects were recruited from the Heart Failure Registry of the Prince of Wales Hospital in Hong Kong between 2006 and 2008 and completed the Minnesota Living with Heart Failure Questionnaire (MLHFQ) at 3 designated time-points conferred eligibility. Patients with significant valvular disorder were excluded. Each patient's medical record was reviewed for 12 months after the date of admission. Heart failure related admissions, clinic visits, cardiovascular drugs, laboratory tests and diagnostic tests were documented. Costs and MLHFQ scores in patients with or without hypertension, diabetes and renal impairment were compared.. A total of 73 HFpEF patients were included. It was found that loop diuretics (93.1%, 78.1%) was the most frequently used agent for HFpEF management in both in-patient and out-patient settings. The mean 1-year direct medical cost was USD$ 19969 (1 US $ = 7.8 HK$), with in-patient ward care contributing to the largest proportion (72.2%) of the total cost. Patients with diabetes or renal impairment were associated with a higher cost of HFpEF management. Significant difference was found in the renal impairment group (median cost: USD$ 24604.2 versus USD$ 12706.8 in no impairment group, p = 0.023). The MLHFQ scores of the subjects improved significantly during the study period (p < 0.0005).. The cost of management of HFpEF was enormous and further increased in the presence of comorbidities.

Topics: Adult; Aged; Aged, 80 and over; Cardiovascular Agents; Diabetes Complications; Direct Service Costs; Diuretics; Female; Heart Failure; Hong Kong; Hospitals, Public; Humans; Hypertension; Male; Middle Aged; Quality of Life; Renal Insufficiency; Retrospective Studies; Stroke Volume; Treatment Outcome

The ratio of revascularization to medical therapy (referred to herein as the revascularization ratio) for the initial treatment of stable ischemic heart disease varies considerably across hospitals. We conducted a comprehensive study to identify patient, physician and hospital factors associated with variations in the revascularization ratio across 18 cardiac centres in the province of Ontario. We also explored whether clinical outcomes differed between hospitals with high, medium and low ratios.. We identified all patients in Ontario who had stable ischemic heart disease documented by index angiography performed between Oct. 1, 2008, and Sept. 30, 2011, at any of the 18 cardiac centres in the province. We classified patients by initial treatment strategy (medical therapy or revascularization). Hospitals were classified into equal tertiles based on their revascularization ratio. The primary outcome was all-cause mortality. Patient follow-up was until Dec. 31, 2012. Hierarchical logistic regression models identified predictors of revascularization. Multivariable Cox proportional hazards models, with a time-varying covariate for actual treatment received, were used to evaluate the impact of the revascularization ratio on clinical outcomes.. Variation in revascularization ratios was twofold across the hospitals. Patient factors accounted for 67.4% of the variation in revascularization ratios. Physician and hospital factors were not significantly associated with the variation. Significant patient-level predictors of revascularization were history of smoking, multivessel disease, high-risk findings on noninvasive stress testing and more severe symptoms of angina (v. no symptoms). Treatment at hospitals with a high revascularization ratio was associated with increased mortality compared with treatment at hospitals with a low ratio (hazard ratio 1.12, 95% confidence interval 1.03-1.21).. Most of the variation in revascularization ratios across hospitals was warranted, in that it was driven by patient factors. Nonetheless, the variation was associated with potentially important differences in mortality.

Topics: Age Factors; Aged; Angina, Stable; Cardiovascular Agents; Cohort Studies; Comorbidity; Coronary Angiography; Coronary Artery Bypass; Databases, Factual; Diabetes Mellitus; Exercise Test; Female; Hospitals; Humans; Hyperlipidemias; Hypertension; Income; Logistic Models; Male; Middle Aged; Myocardial Ischemia; Myocardial Revascularization; Ontario; Percutaneous Coronary Intervention; Peripheral Vascular Diseases; Practice Patterns, Physicians'; Proportional Hazards Models; Pulmonary Disease, Chronic Obstructive; Severity of Illness Index; Smoking

In order to assess the effect of a vascular event on adherence to treatment we examined a total of 68 patients presenting with coronary atherosclerosis. The patients' age varied from 31 to 84 years (mean 57.1±8.7). There were 55 (81.1%) men and 13 (18.9%) women. Drug regimen compliance was evaluated by means of the Morisky-Green Medication Adherence Questionnaire before and after the vascular event. Of the 68 examined patients, 15 (22.1%) had not taken any therapeutic agents before the vascular event occurred, despite existing arterial hypertension. Drug regimen compliance prior to the vascular event was low in 82.4% of cases. The number of patients with coronary atherosclerosis and low compliance to treatment before the vascular event decreased significantly thereafter (p=0.0012). After the vascular event, the number of patients adhering to the doctor's recommendations on medicamentous therapy increases considerably. At the same time, a sufficiently great number of patients [about 30% of patients after endured myocardial infarction (MI) and 18% after transcutaneous coronary intervention (TCI)] still remain in the category of those "having low drug regimen compliance" and, accordingly, have high risk for the development of recurrent vascular events. Endured TCI increases patient compliance more significantly than MI, which requires additional study of a psychological component of the given fact.

Topics: Cardiovascular Agents; Coronary Artery Disease; Female; Humans; Hypertension; Male; Middle Aged; Myocardial Infarction; Needs Assessment; Patient Compliance; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Russia; Secondary Prevention; Surveys and Questionnaires

We previously reported ethnic disparity in adverse outcomes among Asians with type 2 diabetes (T2DM) in Singapore. Central arterial stiffness can aggravate systemic vasculopathy by propagating elevated systolic and pulse pressures forward, thereby accentuating global vascular injury. We aim to study ethnic disparity in central arterial stiffness and its determinants in a multi-ethnic T2DM Asian cohort.. Arterial stiffness was estimated by carotid-femoral pulse wave velocity (PWV) and augmentation index (AI) using applanation tonometry method in Chinese (N = 1045), Malays (N = 458) and Indians (N = 468). Linear regression model was used to evaluate predictors of PWV and AI.. PWV was higher in Malays (10.1 ± 3.0 m/s) than Chinese (9.7 ± 2.8 m/s) and Indians (9.6 ± 3.1 m/s) (P = 0.018). AI was higher in Indians (28.1 ± 10.8%) than Malays (25.9 ± 10.1%) and Chinese (26.1 ± 10.7%) (P < 0.001). Malays remain associated with higher PWV (β = 0.299, P = 0.048) post-adjustment for age, gender, duration of diabetes, hemoglobin A1c, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), soluble receptor for advanced glycation end-products, urinary albumin-to-creatinine ratio, and insulin usage, which were all independent predictors of PWV. Indians remain associated with higher AI (β = 2.776, P < 0.001) post-adjustment for age, gender, BMI, SBP, DBP, and height, which were independent predictors of AI. These variables explained 27.7% and 33.4% of the variance in PWV and AI respectively.. Malays and Indians with T2DM have higher central arterial stiffness, which may explain their higher risk for adverse outcomes. Modifying traditional major vascular risk factors may partially alleviate their excess cardiovascular risk through modulating arterial stiffness.

Topics: Aged; Arteriosclerosis; Asian People; Cardiovascular Agents; China; Comorbidity; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Diabetic Angiopathies; Disease Susceptibility; Female; Glycated Hemoglobin; Glycation End Products, Advanced; Humans; Hypertension; Hypoglycemic Agents; India; Malaysia; Male; Middle Aged; Obesity; Pulse Wave Analysis; Risk Factors; Singapore; Vascular Stiffness

Topics: Aged; Angiography; Arterial Occlusive Diseases; Cardiovascular Agents; Delayed Diagnosis; Diagnosis, Differential; Female; Heart Failure; Hemodiafiltration; Humans; Hypertension; Hypertension, Renovascular; Iliac Artery; Kidney Transplantation; Postoperative Complications; Renal Artery Obstruction; Reoperation; Stents; Ultrasonography, Doppler

Acute aortic dissection (AD) is a catastrophic condition associated with a high rate of mortality. However, current epidemiological information regarding AD remains sparse. The objective of the present study was to investigate the current epidemiological profile and medication utilization patterns associated with aortic dissection in Taiwan.In this population-based study, we identified cases of AD diagnosed during 2005 to 2012 in the complete Taiwan National Health Insurance (NHI) Research Database. Patients with AD were identified using the International Classification of Disease, Ninth Revision (ICD-9) code 441.0, and surgical interventions were defined using NHI procedure codes.A total of 9092 individuals with a mean age of 64.4 ± 15.1 years were identified. The cases were divided into 3 groups: Group A included 2340 patients (25.74%) treated surgically for type A AD; Group B included 1144 patients (12.58%) treated surgically for type B AD, and Group C included 5608 patients (61.68%) with any type of AD treated with medical therapy only. The average annual incidence of AD was 5.6 per 100,000 persons, and the average prevalence was 19.9 per 100,000 persons. Hypertension was the most common risk factor, followed by coronary artery disease and chronic obstructive pulmonary disease. Within 1 year of AD diagnosis, 92% of patients were taking antihypertensive medication. Calcium channel blockers were the most frequently prescribed antihypertensive medication for long-term observation in Taiwan.The annual trends revealed statistically significant increases in the numbers and percentages of prevalence, incidence, and mortality. Changes in patients' drug utilization in patterns were observed after AD diagnosis. Our study provides a local profile that supports further in-depth analyses in AD-affected populations.

Topics: Aged; Aortic Dissection; Aortic Rupture; Cardiovascular Agents; Coronary Artery Disease; Disease Management; Female; Humans; Hypertension; Incidence; Male; Middle Aged; Pulmonary Disease, Chronic Obstructive; Retrospective Studies; Risk Factors; Taiwan

Cardiovascular diseases, such as arterial hypertension, heart failure, coronary artery disease, peripheral circulatory problems and atrial fibrillation are increasingly present in aged patients. Comorbidities, mainly diabetes, renal dysfunction, chronic bronchitis and degenerative joint diseases, are also frequent and need additional drug treatment. The usual polypharmacy often causes side effects due to overdosage and/or drug interactions. The main difficulty in choosing the proper therapeutic regimen consists in the lack of suitable dosing guidelines with adapted therapeutic targets for the older multimorbid population, usually not represented in the large controlled trials forming the basis of general recommendations. European guidelines for hypertension and heart failure are discussed as examples.

Topics: Aged; Aged, 80 and over; Cardiovascular Agents; Cardiovascular Diseases; Combined Modality Therapy; Comorbidity; Dose-Response Relationship, Drug; Drug Interactions; Drug Therapy, Combination; Eplerenone; Female; Guideline Adherence; Heart Failure; Humans; Hypertension; Male; Mineralocorticoid Receptor Antagonists; Pacemaker, Artificial; Risk Factors; Spironolactone

Since 2009, the United Kingdom diving incident data show an increasing number of fatalities in the over-50s age group. Previous studies also suggest some divers take cardiac medications. Since 2001, diving medicals have not been mandatory for UK sport divers. Instead, an annual medical self-certification form, submitted to their club/school or training establishment, is required. We documented in a survey of UK sport divers the prevalence of cardiac events and medications and the frequency of medical certifications.. An anonymous on-line questionnaire was publicised. Measures included diver and diving demographics, prescribed medications, diagnosed hypertension, cardiac issues, events and procedures, other health issues, year of last diving medical, diagnosed persistent foramen ovale (PFO), smoking and alcohol habits, exercise and body mass index.. Of 672 completed surveys, hypertension was reported by 119 (18%) with 25 of these (21%) having not had a diving medical. Myocardial infarction 6 (1%), coronary artery bypass grafting 3 (< 1%), atrial fibrillation 19 (3%) and angina 12 (2%) were also reported. PFOs were reported by 28 (4%), with 20 of these opting for a closure procedure. From 83 treated incidences of decompression illness (DCI), 19 divers reported that a PFO was diagnosed.. Divers inevitably develop health problems. Some continue to dive with cardiac issues, failing to seek specialised diving advice or fully understand the role of the diving medical. Physicians without appropriate training in diving medicine may inform a diver they are safe to continue diving with their condition without appreciating the potential risks. The current procedure for medical screening for fitness to dive may not be adequate for all divers.

Topics: Adolescent; Adult; Age Distribution; Aged; Alcohol Drinking; Angina Pectoris; Atrial Fibrillation; Body Mass Index; Cardiovascular Agents; Cardiovascular Diseases; Certification; Coronary Artery Bypass; Decompression Sickness; Diving; Exercise; Female; Foramen Ovale, Patent; Health Status; Humans; Hypertension; Male; Middle Aged; Myocardial Infarction; Recreation; Smoking; Surveys and Questionnaires; Time Factors; United Kingdom

Heart failure (HF) is a progressive disorder associated with impaired quality of life, high morbidity, mortality and frequent hospitalization and affects millions of people from all around the world. Despite further improvements in HF therapy, mortality and morbidity remains to be very high. The life-long treatment, frequent hospitalization, and sophisticated and very expensive device therapies for HF also leads a substantial economic burden on the health care system. Therefore, implementation of evidence-based guideline-recommended therapy is very important to overcome its worse clinical outcomes. However, HF therapy is a long process that has many drawbacks and sometimes HF guidelines cannot answers to every question which rises in everyday clinical practice. In this paper, commonly encountered questions, overlooked points, controversial issues, management strategies in grey zone and problems arising during follow up of a HF patient in real life clinical practice have been addressed in the form of expert opinions based on the available data in the literature.

Topics: Adrenergic beta-Antagonists; Aged; Anemia; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Atrial Fibrillation; Cardiovascular Agents; Chronic Disease; Diabetes Mellitus; Diuretics; Evidence-Based Medicine; Female; Heart Failure; Humans; Hypertension; Hypertension, Pulmonary; Male; Middle Aged; Mineralocorticoid Receptor Antagonists; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications, Cardiovascular; Pulmonary Disease, Chronic Obstructive; Renal Insufficiency, Chronic; Turkey

To determine whether drugs used in treatment of cardiovascular diseases (CVD-drugs), including hypertension, increase the risk of fragility fractures in individuals above the age of 65 years.. Retrospective nationwide cohort study.. Danish nationwide national registers.. All individuals in Denmark ≥ 65 years who used specified CVD-drugs in the study period between 1999 and 2012.. Time-dependent exposure to CVD-drugs (nitrates, digoxin, thiazides, furosemide, ACE inhibitors, angiotensin receptor antagonists, β-blockers, calcium antagonists and statins) was determined by prescription claims from pharmacies. The association between use of specific CVD-drugs and fragility fractures was assessed using multivariable Poisson regression models, and adjusted incidence rate ratios (IRRs) were calculated.. Overall, 1,586,554 persons were included, of these 16.1% experienced a fall-related fracture. The multivariable Poisson regression analysis showed positive associations between fracture and treatment with furosemide, thiazide and digoxin. IRRs during the first 14 days of treatment were for furosemide IRR 1.74 (95% CI 1.61 to 1.89) and for thiazides IRR 1.41 (1.28 to 1.55); IRR during the first 30 days of treatment with digoxin was 1.18 (1.02 to 1.37).. Use of furosemide, thiazides and digoxin was associated with elevated rates of fragility fractures among elderly individuals. This may warrant consideration when considering diuretic treatment of hypertension in elderly individuals.

Topics: Accidental Falls; Aged; Aged, 80 and over; Cardiovascular Agents; Denmark; Digoxin; Female; Fractures, Bone; Furosemide; Humans; Hypertension; Male; Multivariate Analysis; Regression Analysis; Retrospective Studies; Risk Assessment; Risk Factors; Thiazides

Inflammatory responses mediate the development of perivascular fibrosis and heart dysfunction induced by hypertension. Complement is an important inflammatory system, and we aimed to evaluate the effect of a specific C5a receptor antagonist (C5aRA), PMX53, on inflammation and perivascular fibrosis in the hypertensive heart of the mouse.. Hypertension was induced by angiotensin II (Ang II) subcutaneously infused at a dose of 1500 ng/kg/min for 7 days. PMX53 was administrated at a dose of 1mg/kg, intraperitoneally 1 day before and daily during Ang II infusion.. Although C5aRA treatment did not affect the elevated blood pressure by Ang II infusion, it reduced cardiomyocyte hypertrophy, cardiac inflammation, and perivascular fibrosis. The mRNA and protein levels of the profibrotic cytokines transforming growth factor β1 (TGF-β1) and connective tissue growth factor (CTGF), as measured by real-time polymerase chain reaction and immunohistochemistry staining, were also attenuated by C5aRA treatment after Ang II infusion.. Our data suggest that inhibition of C5aR could be a potential therapeutic strategy in preventing organ damage in Ang II-induced hypertension.

Topics: Angiotensin II; Animals; Cardiomegaly; Cardiovascular Agents; Collagen; Connective Tissue Growth Factor; Cytokines; Disease Models, Animal; Fibrosis; Hypertension; Mice, Inbred C57BL; Myocardium; Peptides, Cyclic; Receptor, Anaphylatoxin C5a; RNA, Messenger; Time Factors; Transforming Growth Factor beta1; Ventricular Remodeling

Although antihypertensive drugs are known to reduce mortality in individuals with hypertension, the effects of different cardiovascular pharmacotherapies on mortality among patients with hypertension and atrial fibrillation (AF) have been less thoroughly explored. To study mortality rates in men and women separately with hypertension and AF prescribed different cardiovascular pharmacotherapies. A cohort of men (n=2809) and women (n=2793) aged >45 years diagnosed with hypertension and AF were selected using patient records. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox regression, with all-cause mortality as the outcome. Analysis was performed on the whole population and after stratification by age and sex. Independent factors were prescribed pharmacotherapies. Adjustments were made for a propensity score comprising age, comorbidities, education and marital status. The higher the number of antihypertensive drugs prescribed, the lower the mortality rate (P-value for trend 0.005). Individuals prescribed 4-5 antihypertensive drugs had a lower risk of mortality than those prescribed 0-1 drugs (HR: 0.62; 95% CI: 0.45-0.86). The HRs for the following drug classes were: loop diuretics 1.39 (95% CI: 1.08-1.78), non-selective β-blockers 0.68 (95% CI: 0.53-0.88), angiotensin receptor blockers 0.75 (95% CI: 0.56-0.99) and statins 0.68 (95% CI: 0.53-0.88). AF patients with hypertension prescribed statins, non-selective β-blockers and angiotensin receptor blockers had low relative mortality risks, suggesting that these prescribed pharmacotherapies were beneficial. This needs to be further explored in other clinical settings.

Topics: Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Angiotensin Receptor Antagonists; Antihypertensive Agents; Atrial Fibrillation; Cardiovascular Agents; Cohort Studies; Comorbidity; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Hypertension; Male; Middle Aged; Regression Analysis; Sodium Potassium Chloride Symporter Inhibitors; Sweden; Treatment Outcome

Topics: Antihypertensive Agents; Atrial Fibrillation; Cardiovascular Agents; Female; Humans; Hypertension; Male

We aimed to identify factors easily collected at admission in patients with transient ischemic attack (TIA) that were associated with early recurrence, so as to guide clinicians' decision-making about hospitalization in routine practice. From September 2011 to January 2013, all TIA patients who were referred to the University Hospital of Dijon, France, were identified. Vascular risk factors and clinical information were collected. The etiology of the TIA was defined according to the results of complementary examinations performed at admission as follows: large artery atherosclerosis (LAA-TIA) TIA, TIA due to atrial fibrillation (AF-TIA), other causes, and undetermined TIA. Logistic regression analyses were performed to identify factors associated with any recurrence at 48 hours (stroke or TIA). Among the 312 TIA patients, the etiology was LAA-TIA in 33 patients (10.6%), AF-TIA in 57 (18.3%), other causes in 23 (7.3%), and undetermined in 199 (63.8%). Early recurrence rates were 12.1% in patients with LAA-TIA, 5.3% in patients with AF-TIA, 4.3% in patients with another cause of TIA, and 1.0% in patients with undetermined TIA. In multivariable analysis, the LAA etiology was independently associated with early recurrence (odds ratio [OR]: 12.03; 95% confidence interval [CI]: 1.84-78.48, p=0.009). A non-significant trend was also observed for AF-TIA (OR: 3.82; 95% CI: 0.40-36.62, p=0.25) and other causes (OR: 3.73; 95% CI: 0.30-46.26, p=0.31). A simple initial assessment of TIA patients in the emergency room would be helpful in targeting those with a high risk of early recurrence and who therefore need to be hospitalized.

Topics: Aged; Aged, 80 and over; Atherosclerosis; Atrial Fibrillation; Cardiovascular Agents; Coronary Disease; Diabetes Mellitus; Diagnostic Imaging; Emergencies; Female; France; Humans; Hypercholesterolemia; Hypertension; Ischemic Attack, Transient; Length of Stay; Male; Middle Aged; Patient Admission; Recurrence; Risk Factors; Smoking

Eosinophils have been involved in a wide spectrum of pro-inflammatory and pro-thrombotic conditions, with the development of cardiovascular complications in a significant proportion of hypereosinophilic patients. However, no study has so far evaluated the impact of eosinophils levels on periprocedural myocardial infarction (PMI) in patients undergoing non-urgent percutaneous coronary interventions (PCI), that was, then, aim of current study.. In a consecutive cohort of patients, myonecrosis biomarkers were dosed at intervals from 6 to 48 h after PCI. Periprocedural myonecrosis was defined as troponin I increase by 3 times the ULN or by 50% of an elevated baseline value, whereas PMI as CKMB increase by 3 times the ULN or 50% of baseline.. Our population is represented by 1543 patients who were divided according to tertiles of absolute eosinophils count (AEC ≤ 0.1; 0.1-0.2; >0.2 × 10ˆ3/ml). Higher AEC was related to male gender (p = 0.002), arterial hypertension (p = 0.02), diabetes (p = 0.001), previous coronary revascularization (p = 0.003 for PCI, p = 0.03 for CABG), treatment with ARBs, beta-blockers, diuretics and ASA (p < 0.001), statins (p = 0.02), calcium antagonists (p = 0.05), glycosylated hemoglobin (p < 0001), creatinine levels (p = 0.001) and platelet count (p = 0.01), while inversely with acute presentation (p < 0.001), glycemia (p = 0.03), HDL-cholesterol and C-reactive protein (p = 0.02). AEC related with multivessel coronary artery disease (p = 0.05), lesion length (p = 0.01), drug eluting stents implantation (p = 0.001) and use of kissing balloon technique (p = 0.05), while inversely to intracoronary thrombus (p < 0.001) and thrombectomy (p = 0.04). AEC did not influence the occurrence of PMI (p = 0.06, adjusted OR [95% CI] = 1.06 [0.86-1.31], p = 0.57) or myonecrosis (p = 0.15, adjusted OR [95% CI] = 1.06 [0.88-1.27], p = 0.53). Results were confirmed at subgroup analysis in higher-risk subsets of patients.. In patients undergoing non-urgent PCI, eosinophils levels are not associated with the occurrence of periprocedural myocardial infarction or myonecrosis.

Topics: Aged; Biomarkers; C-Reactive Protein; Cardiovascular Agents; Cholesterol, HDL; Comorbidity; Coronary Thrombosis; Creatinine; Diabetes Mellitus; Eosinophils; Female; Glycated Hemoglobin; Humans; Hypertension; Leukocyte Count; Male; Middle Aged; Myocardial Infarction; Myocardium; Necrosis; Percutaneous Coronary Intervention; Platelet Count; Recurrence; Renal Insufficiency; Retrospective Studies; Smoking; Stents; Thrombectomy

Topics: Cardiology; Cardiovascular Agents; Heart Diseases; History, 19th Century; History, 20th Century; Humans; Hypertension

Topics: Alcohol Drinking; Cardiovascular Agents; Cardiovascular Diseases; Coronary Disease; Diabetes Complications; Drug Combinations; Dyslipidemias; Female; History, 20th Century; History, 21st Century; Humans; Hypertension; Medication Adherence; Menopause; Metabolic Syndrome; Obesity; Risk Factors; Sedentary Behavior; Smoking; Women's Health

Topics: Angioplasty, Balloon, Coronary; Cardiomyopathy, Dilated; Cardiovascular Agents; Coronary Angiography; Coronary Artery Disease; Diabetes Mellitus, Type 2; False Negative Reactions; Follow-Up Studies; Humans; Hypertension; Internal Mammary-Coronary Artery Anastomosis; Magnetic Resonance Imaging; Male; Middle Aged; Myocardial Infarction; Myocardial Perfusion Imaging; Myocardial Stunning; Overweight; Reoperation; Stents; Stroke Volume

To demonstrate the utilization of a clinical improvement program in stable coronary artery disease patients to increase the evidence-proven treatment utilization, and to describe the ongoing clinical practice and lifestyle change counseling.. Cross-sectional study followed by a longitudinal component in which the tools utilization to improve clinical practice was assessed by means of additional cross-sectional data collection. 710 consecutive patients were included (Phase 1). After tools implementation, within 6 months period, 705 patients were included (Phase 2) for comparative analysis. Randomly, 318 patients from Phase 1 were selected, 6-12 months after the first evaluation (Phase 3).. Phase 1 to Phase 2: there were improvement on smoking cessation (P=0.019), dyslipidemia (P<0.001), hypertension and physical activity (P<0.001). There was significant difference on angiotensin converting enzyme inhibitors - ACEI (67.2% vs. 56.8%, P<0.001); angiotensin II receptor blockers - ARB II (25.4% vs. 32.9%, P=0.002) and beta-blocker (88.7% vs. 91.9%, P=0.047). Phase 1 to Phase 3: there was both weight (P=0.044), and blood pressure reduction (P<0.001). There was statistical significant difference on ACEI (64.8% vs. 61.6%, P=0.011) and ARB II (27.0% vs. 31.3%, P=0.035).. There was no significant change on the evidence-based pharmacological treatment utilization between pre and post-intervention phases; there was significant improvement concerning smoking and physical activity in phase 2; substantial improvement on blood pressure levels in both comparisons (Phase 1 to 2 and Phase 1 to 3). The inclusion of a case-manager for the process management was crucial for program efficacy. Comprehensive programs for clinical practice should be pursued for longer follow-up period.

Topics: Adult; Aged; Aged, 80 and over; Cardiovascular Agents; Coronary Disease; Cross-Sectional Studies; Dyslipidemias; Female; Guideline Adherence; Humans; Hypertension; Life Style; Male; Middle Aged; Reproducibility of Results; Risk Factors; Secondary Prevention; Smoking Cessation; Time Factors; Treatment Outcome

Estrogens promote beneficial effects in the cardiovascular system mainly through the estrogen receptor (ER)α and ERβ, which act as ligand-gated transcription factors. Recently, the G protein-coupled estrogen receptor (GPER) has been implicated in the estrogenic signaling in diverse tissues, including the cardiovascular system. In this study, we demonstrate that left ventricles of male Spontaneously Hypertensive Rats (SHR) express higher levels of GPER compared to normotensive Wistar Kyoto (WKY) rats. In addition, we show that the selective GPER agonist G-1 induces negative inotropic and lusitropic effects to a higher extent in isolated and Langendorff perfused hearts of male SHR compared to WKY rats. These cardiotropic effects elicited by G-1 involved the GPER/eNOS transduction signaling, as determined by using the GPER antagonist G15 and the eNOS inhibitor L-NIO. Similarly, the G-1 induced activation of ERK1/2, AKT, GSK3β, c-Jun and eNOS was abrogated by G15, while L-NIO prevented only the eNOS phosphorylation. In hypoxic Langendorff perfused WKY rat heart preparations, we also found an increased expression of GPER along with that of the hypoxic mediator HIF-1α and the fibrotic marker CTGF. Interestingly, G15 and L-NIO prevented the ability of G-1 to down-regulate the expression of both HIF-1α and CTGF, which were found expressed to a higher extent in SHR compared to WKY rat hearts. Collectively, the present study provides novel data into the potential role played by GPER in hypertensive disease on the basis of its involvement in myocardial inotropism and lusitropism as well as the expression of the apoptotic HIF-1α and fibrotic CTGF factors. Hence, GPER may be considered as a useful target in the treatment of some cardiac dysfunctions associated with stressful conditions like the essential hypertension.

Topics: Animals; Benzodioxoles; Cardiovascular Agents; Connective Tissue Growth Factor; Cyclopentanes; Gene Expression Regulation; Glycogen Synthase Kinase 3; Glycogen Synthase Kinase 3 beta; Heart; Hypertension; Hypoxia-Inducible Factor 1, alpha Subunit; JNK Mitogen-Activated Protein Kinases; Male; Mitogen-Activated Protein Kinase 1; Mitogen-Activated Protein Kinase 3; Muscle Relaxation; Nitric Oxide Synthase Type III; Organ Culture Techniques; Ornithine; Proto-Oncogene Proteins c-akt; Quinolines; Rats; Rats, Inbred SHR; Rats, Inbred WKY; Receptors, G-Protein-Coupled; Signal Transduction

Cardiovascular diseases are the first cause of death in elderly patients. So it seems important to estimate the adequacy of the medical prescriptions to the guidelines in this population and for these diseases. A retrospective analysis was performed in nine hospitals on 736 patients aged 65 years old and over hospitalized in the acute care geriatric unit. Cardiovascular prescribing were analyzed for each patient according to STOPP and START. The population (n=736) has a mean age of 86.7 years and belongs in 45.0% of the cases to the group of dependence GIR3-4. According to STOPP, two inappropriate prescriptions are noticed: calcium channel blockers with chronic constipation concerning 9% of the included population and aspirin at dose > 150 mg/day representing 8.4% of this population. According to START, angiotensin converting enzyme inhibitor are under-prescribed in elderly patients with heart failure (140 patients = 19.0% of the population) and following acute myocardial infarction (116 patients = 15.8%). Anticoagulation in patients with atrial fibrillation is also under-prescribed: 82 patients are concerned (11.0% of the population). The prescription of ACE inhibitor is influenced by renal insufficency in patients with heart failure. The anticoagulation in atrial fibrillation is age and dependence-related. This analysis demonstrates an inadequacy between the clinical practice and guidelines for two major cardiovascular diseases: the heart failure and the atrial fibrillation. The importance of the inadequacy was suspected of opportunities for improvement, in particular in the presence of their risk factors: very elderly patients, loss of autonomy and renal insufficiency.

Topics: Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Atrial Fibrillation; Calcium Channel Blockers; Cardiovascular Agents; Cardiovascular Diseases; Comorbidity; Constipation; Drug Utilization; Female; France; Guideline Adherence; Heart Failure; Humans; Hypertension; Inappropriate Prescribing; Male; Myocardial Infarction; Retrospective Studies

Topics: Acute Coronary Syndrome; Aged, 80 and over; Aortic Diseases; Atherosclerosis; Calcinosis; Cardiovascular Agents; Colitis, Ischemic; Dietary Supplements; Humans; Hyperparathyroidism, Secondary; Hypertension; Hypotension; Kidney Failure, Chronic; Male; Myocardial Ischemia; Nephrosclerosis; Obesity; Parenteral Nutrition; Pneumatosis Cystoides Intestinalis; Renal Dialysis; Splanchnic Circulation

Long-term treatment of patients with essential hypertension (EH) and autonomic dysfunction (sympathicotonia type) with lisinopril in combination with indapamide augmented activity of humoral systems and improved heart rate variability. Addition of a selective beta-blocker bisoprolol to lisinopril/indapamide combination promoted normalization of humoral activity. This gives reason to apply tiered RAAS blockade in order to ensure more effective control of activity of neurohumoral systems in patients with EH ant initial sympathicotonia.

Topics: Adult; Antihypertensive Agents; Cardiovascular Agents; Data Interpretation, Statistical; Drug Monitoring; Drug Synergism; Drug Therapy, Combination; Essential Hypertension; Female; Heart Rate; Humans; Hypertension; Indapamide; Lisinopril; Male; Neurotransmitter Agents; Severity of Illness Index; Sympathetic Nervous System; Treatment Outcome

Under observation were 40 hypertensive patients with coronary heart disease, gout and obesity I and II degree. Patients with hypertension in combination with coronary heart disease, gout and obesity, syndrome of early vascular aging is shown by increased stiffness of arteries, increased peak systolic flow velocity, pulse blood presure, the thickness of the intima-media complex, higher level endotelinemia and reduced endothelial vasodilation. Obtained evidence that losartan in complex combination with basic therapy and metamaks in complex combination with basic therapy positively affect the elastic properties of blood vessels and slow the progression of early vascular aging syndrome.

Topics: Antihypertensive Agents; Blood Flow Velocity; Blood Pressure; Cardiovascular Agents; Carotid Arteries; Coronary Disease; Elasticity; Endothelium, Vascular; Female; Gout; Humans; Hypertension; Losartan; Male; Methylhydrazines; Middle Aged; Obesity; Severity of Illness Index; Tunica Intima; Tunica Media; Vascular Stiffness

The management of coronary artery disease has made important progress. Adherence to therapeutic measures is a great challenge for improving the long-term prognosis. In this work, we evaluate factors related to therapeutic adherence in black African patients with stable coronary artery disease.. We conducted a survey over three months (February-May 2008) in three cardiology departments in Dakar. We studied the regularity of drug intake, the adherence to the dietary advices and the appointments for consultation as well as the factors related to adherence. Good adherence was defined by a compliance rate greater or equal to 80% and a compliance rate less than 40% defined poor adherence.. We included 105 patients (61 men) with a mean age of 60.67±11.29 years. Good compliance was noted in 56.2% of cases for drug treatment, 42% for dietary advices and 65% for appointments for consultation. A history of acute coronary events (P=0.04), a good knowledge of the disease (P=0.03) and a healthcare (P=0.02) were the factors related to a good adherence to drug treatment, whereas ischemic cardiomyopathy was a factor for poor adherence (P=0.002). Knowledge of coronary disease was the only factor correlated with good adherence to lifestyle (P=0.014).. Therapeutic adherence remains unsatisfactory in Black African patients with stable coronary artery disease, hence the importance of patient education to reach a good adherence for therapeutic, because better adherence improves long-term prognosis of coronary artery disease.

Topics: Adult; Aged; Aged, 80 and over; Ambulatory Care; Black People; Cardiovascular Agents; Combined Modality Therapy; Coronary Artery Disease; Developing Countries; Diabetes Mellitus, Type 2; Exercise; Female; Humans; Hypercholesterolemia; Hypertension; Male; Medication Adherence; Middle Aged; Obesity, Abdominal; Risk Factors; Sedentary Behavior; Senegal; Smoking

To quantify how much of the coronary heart disease (CHD) mortality decline in Northern Ireland between 1987 and 2007 could be attributed to medical and surgical treatments and how much to changes in population cardiovascular risk factors.. The IMPACT mortality model was used to integrate data on uptake and effectiveness of cardiological treatments and risk factor trends in the Northern Ireland population between 1987 and 2007. The main data sources were official population and mortality statistics, hospital administration systems, primary care datasets, published trials and meta-analyses, clinical audits, and national surveys. Between 1987 and 2007, CHD mortality rates in Northern Ireland decreased by 52% in men and 60% in women aged 25-84 years. This resulted in 3180 fewer deaths in 2007 than expected if 1987 mortality rates had persisted. Approximately 35% of this decrease was attributed to increased uptake of treatments in individuals and 60% to population risk factor reductions (principally blood pressure, total cholesterol, and smoking); however, these reductions were partially offset by adverse trends in diabetes, physical inactivity, and obesity.. Approximately 60% of the substantial CHD mortality decline in Northern Ireland between 1987 and 2007 was attributable to major cardiovascular risk factor changes and approximately 35% was attributable to treatments. However, adverse trends in diabetes, obesity, and physical inactivity are of major concern.

Topics: Adult; Aged; Aged, 80 and over; Cardiac Surgical Procedures; Cardiovascular Agents; Comorbidity; Coronary Disease; Diabetes Mellitus; Diet; Exercise; Female; Humans; Hypercholesterolemia; Hypertension; Male; Middle Aged; Models, Statistical; Northern Ireland; Obesity; Preventive Health Services; Prognosis; Risk Assessment; Risk Factors; Risk Reduction Behavior; Sedentary Behavior; Smoking Cessation; Time Factors

No information exists, to our knowledge, about the possible role of cardiovascular drug administration in the acute phase of ischemic stroke and possible effects on stroke outcome. The aim of our study was to evaluate the relationship between in-hospital treatment with cardiovascular drugs in patients with acute ischemic stroke and some outcome indicators.. 1096 subjects enrolled in the GIFA study, who had a main discharge diagnosis of ischemic stroke represent the final sample. Drugs considered for the analysis were the following: ACE-inhibitors (ACEI), angiotensin II receptor blockers (ARBs), statins, calcium-channel-blockers (CCBs), antiplatelet (APL) drugs, antivitamin-k (VKAs), and heparins. As outcome indicators we choose in-hospital mortality, cognitive function evaluated by Hodkinson Abbreviated Mental Test (HAMT), and functional status evaluated by activity daily living (ADL). Indicators of a good outcome were: no in-hospital mortality, HAMT >6 and 0 ADL impaired. Patients with a good outcome showed a higher rate of in-hospital treatment with ACE-inhibitors, calcium-channel blockers and a lower rate of pre-treatment with heparin.. Our study suggests that if a patient with acute ischemic stroke has higher SBP at admission, higher total cholesterol plasma levels, a lower Charlson index and is treated with ACE-inhibitors, calcium channel blockers and antiplatelet drugs, the short term outcome is better in terms of in-hospital mortality and functional indicators such as cognitive and functional performance at discharge.

Topics: Activities of Daily Living; Aged; Angiotensin-Converting Enzyme Inhibitors; Brain Ischemia; Calcium Channel Blockers; Cardiovascular Agents; Cognition Disorders; Comorbidity; Female; Geriatric Assessment; Humans; Hypercholesterolemia; Hypertension; Italy; Male; Platelet Aggregation Inhibitors; Prognosis; Retrospective Studies; Stroke; Time Factors

Topics: Angiography; Anti-Inflammatory Agents; Arterial Occlusive Diseases; Cardiovascular Agents; Cryoglobulinemia; Cryoglobulins; Diabetes Mellitus, Type 2; Diagnostic Imaging; Drug Therapy, Combination; Female; Fibrinogens, Abnormal; Fingers; Humans; Hypertension; Ischemia; Ischemic Attack, Transient; Middle Aged

We studied all patients admitted to hospital with first onset atrial fibrillation (AF) to determine the probability of spontaneous conversion to sinus rhythm and to identify factors predictive of such a conversion.. We retrospectively reviewed charts of 438 consecutive patients admitted to hospital with first onset AF from 1 January 2006 to 31 December 2009. The patients were divided into two groups, recent onset AF defined as AF < 48 h or longer lasting AF, defined as AF > 48 h.. Spontaneous conversion occurred in 54% (n = 203; 95% confidence interval: 49-59%). In the group with first onset AF < 48 h, spontaneous conversion occurred in 77%, compared with 36% in the group with first onset AF > 48 h. Logistic regression analysis identified duration of AF as a highly significant predictor of spontaneous conversion to sinus rhythm (odds ratio 5.9; 95% confidence interval: 4.0-8.6, P < 0.001).. Spontaneous conversion occurred in 54%, increasing to 77% when AF had persisted less than 48 h.

Topics: Age of Onset; Aged; Atrial Fibrillation; Cardiovascular Agents; Cerebrovascular Disorders; Comorbidity; Diabetes Mellitus; Echocardiography; Electric Countershock; Electrocardiography; Female; Humans; Hypertension; Infections; Inpatients; Male; Middle Aged; Remission, Spontaneous; Retrospective Studies; Risk Factors; Stroke Volume; Time Factors

Topics: Aspirin; Blood Pressure; Cardiovascular Agents; Cerebrovascular Disorders; Diabetes Mellitus, Type 2; Diabetic Angiopathies; Female; Humans; Hypertension; Male; Primary Prevention

Topics: Adult; Aged; Antihypertensive Agents; Biomarkers; Blood Pressure; Cardiology; Cardiovascular Agents; Cardiovascular Diseases; Chronic Disease; Delivery of Health Care; Diabetes Mellitus, Type 2; Diabetic Angiopathies; Diagnostic Imaging; Diet; Drug Combinations; Early Diagnosis; Electronic Health Records; Evidence-Based Medicine; Exercise; Female; General Practice; Health Promotion; Hospitalization; Humans; Hypercholesterolemia; Hypertension; Life Style; Lipids; Male; Medication Adherence; Middle Aged; Nurse's Role; Obesity; Patient Selection; Physician's Role; Primary Health Care; Prognosis; Risk Assessment; Risk Reduction Behavior; Self Care; Smoking; Smoking Cessation; Smoking Prevention; Socioeconomic Factors; Stress, Psychological

Topics: Aged; Cardiovascular Agents; Comorbidity; Diabetic Foot; Diabetic Nephropathies; Disease Management; Dyslipidemias; Female; Glycated Hemoglobin; Guideline Adherence; Humans; Hypertension; Hypoglycemic Agents; Insulin; Kidney Failure, Chronic; Male; Middle Aged; Patient Compliance; Retrospective Studies; Secondary Prevention; Smoking

We describe in this article a clinical case of a patient with arterial hypertension, painless myocardial ischemia and extensive constrictive atherosclerosis of coronary arteries. Coronary heart disease (painless ischemia) was suspected basing on results of transesophageal electrostimulation coupled with stress echocardiography and was confirmed by coronary angiography. This description is followed by discussion of possibilities of different instrumental methods in diagnostics of painless ischemia, classification of painless ischemia, treatment, and prognosis.

Topics: Angioplasty; Anticholesteremic Agents; Asymptomatic Diseases; Atorvastatin; Cardiovascular Agents; Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Drug-Eluting Stents; Echocardiography; Electrophysiologic Techniques, Cardiac; Exercise Test; Heptanoic Acids; Humans; Hyperlipidemias; Hypertension; Male; Middle Aged; Myocardial Ischemia; Pyrroles; Severity of Illness Index; Treatment Outcome

Cardiac fibrosis is a hallmark of heart disease and plays a vital role in cardiac remodeling during heart diseases, including hypertensive heart disease. Hexarelin is one of a series of synthetic growth hormone secretagogues (GHSs) possessing a variety of cardiovascular effects via action on GHS receptors (GHS-Rs). However, the role of hexarelin in cardiac fibrosis in vivo has not yet been investigated. In the present study, spontaneously hypertensive rats (SHRs) were treated with hexarelin alone or in combination with a GHS-R antagonist for 5 wk from an age of 16 wk. Hexarelin treatment significantly reduced cardiac fibrosis in SHRs by decreasing interstitial and perivascular myocardial collagen deposition and myocardial hydroxyproline content and reducing mRNA and protein expression of collagen I and III in SHR hearts. Hexarelin treatment also increased matrix metalloproteinase (MMP)-2 and MMP-9 activities and decreased myocardial mRNA expression of tissue inhibitor of metalloproteinase (TIMP)-1 in SHRs. In addition, hexarelin treatment significantly attenuated left ventricular (LV) hypertrophy, LV diastolic dysfunction, and high blood pressure in SHRs. The effect of hexarelin on cardiac fibrosis, blood pressure, and cardiac function was mediated by its receptor, GHS-R, since a selective GHS-R antagonist abolished these effects and expression of GHS-Rs was upregulated by hexarelin treatment. In summary, our data demonstrate that hexarelin reduces cardiac fibrosis in SHRs, perhaps by decreasing collagen synthesis and accelerating collagen degradation via regulation of MMPs/TIMP. Hexarelin-reduced systolic blood pressure may also contribute to this reduced cardiac fibrosis in SHRs. The present findings provided novel insights and underscore the therapeutic potential of hexarelin as an antifibrotic agent for the treatment of cardiac fibrosis.

Topics: Animals; Blood Pressure; Cardiovascular Agents; Collagen Type I; Collagen Type III; Disease Models, Animal; Fibrosis; Gene Expression Regulation; Heart Diseases; Hydroxyproline; Hypertension; Hypertrophy, Left Ventricular; Male; Matrix Metalloproteinase 2; Matrix Metalloproteinase 9; Myocardium; Oligopeptides; Rats; Rats, Inbred SHR; Rats, Wistar; Receptors, Ghrelin; RNA, Messenger; Time Factors; Tissue Inhibitor of Metalloproteinase-1; Ventricular Dysfunction, Left; Ventricular Function, Left

Gentiana floribunda was investigated for the possible hypotensive and vasodilator activities in an attempt to rationalize its traditional use in hypertension.. The crude extract of Gentiana floribunda (Gf.Cr) was studied in anaesthetized rats and isolated thoracic aorta tissues.. Gf.Cr which tested positive for presence of flavonoids, saponins, sterols, tannins and terpenes caused dose-dependent (3.0-100 mg/kg) fall in arterial blood pressure (BP) of rats under anaesthesia. In rat aortic ring preparations denuded of endothelium, Gf.Cr at concentration range of 1.0-10 mg/mL relaxed high K+ (80 mM) and phenylephrine (PE, 1 μM)-induced contractions and shifted Ca++ dose-response curves to right, similar to that caused by verapamil. It also suppressed PE (1 μM) control peak responses at 0.3-1.0 mg/mL, obtained in Ca++-free medium, as exhibited by verapamil. Pre-treatment of tissues with Gf.Cr produced rightward non-parallel shift of PE-curves with decline of maximum contractile response. The vasodilator effect of Gf.Cr was endothelial-independent, as it was not blocked by Nω-nitro-L-arginine methyl ester hydrochloride, atropine and indomethacin in endothelium-intact aortic tissues.. These data indicate that BP-lowering action of Gentiana floribunda occurred via Ca++ antagonism (inhibition of Ca++ ingress and release from intracellular stores), which provides pharmacological basis to justify its effectiveness in hypertension.

Topics: Animals; Antihypertensive Agents; Aorta, Thoracic; Arginine; Atropine; Blood Pressure; Calcium; Cardiovascular Agents; Dose-Response Relationship, Drug; Endothelium, Vascular; Gentiana; Hypertension; Indomethacin; Male; Phenylephrine; Phytotherapy; Plant Extracts; Potassium; Rats; Rats, Sprague-Dawley; Signal Transduction; Vasoconstriction; Vasodilator Agents; Verapamil

Cardiovascular diseases (CVDs) are the main cause of morbidity and mortality all over the world. Acute myocardial infarction (AMI) is the leading cause of death and disability in the Iranian population. This prospective comprehensive study aimed to assess the clinical characteristics and in-hospital outcomes with possible correlations between them in patients with AMI.. From December 2009 to January 2011, patients admitted with ST-segment elevation myocardial infarction were included in this study. Patients' demographic data, drug history, prehospital delay, door-to-needle or door-to-balloon interval (time to order), type of intervention, presence of arrhythmia, hemodynamic parameters, Framingham risk score, electrocardiogram findings and laboratory data were recorded. Also the length of patients' hospitalization and in-hospital outcome were documented. The correlations between patients' baseline clinical data and in-hospital outcomes were investigated.. During the study period, 167 patients with a median age (range) of 61 (29-92) years were enrolled in our study. Patients' prehospital delay had the median (range) of 3 (0.5-48) h. Eighty-eight (52.7%) patients received streptokinase, for whom the median (range) of door-to-needle time was 30 (6-330) min. The door-to-balloon median (range) time of 44 (26.4%) patients treated with primary percutaneous coronary intervention (PCI) was 30 (60-300) min. Thirty-five (20.9%) patients were not eligible for thrombolysis or PCI due to late arrival (delay of more than 12 h). There were significant relationships between older ages of patients and occurrence of arrhythmia (P = 0.027), hypertension (P = 0.009) and consuming cardiovascular (P = 0.002) agents. In a multivariate analysis, younger individuals [odds ratio (OR) 0.036, 95% confidence interval (CI) 0.003-0.069] and those reperfused with primary PCI (OR 0.44, 95% CI 0.39-0.47) had significantly shorter hospital stays (discharged within a week).. Our results provide emphasis on prevention of cardiovascular risk factors and further support to decrease patients' prehospital delay and accelerate in-hospital interventions for patients with AMI.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Arrhythmias, Cardiac; Biomarkers; Cardiovascular Agents; Comorbidity; Coronary Angiography; Cross-Sectional Studies; Electrocardiography; Female; Fibrinolytic Agents; Hospitals, Teaching; Humans; Hypertension; Iran; Length of Stay; Logistic Models; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction; Odds Ratio; Percutaneous Coronary Intervention; Prospective Studies; Referral and Consultation; Risk Assessment; Risk Factors; Streptokinase; Thrombolytic Therapy; Time Factors; Time-to-Treatment; Treatment Outcome

Hypertension is the most common comorbidity among heart failure (HF) patients and has been independently linked with cognitive impairment. Cognitive impairment is prevalent among HF patients, though the extent to which hypertension contributes to cognitive function in this population is unclear.. 116 HF patients (31.0% women, 67.68 ± 11.16 years) completed neuropsychological testing and impedance cardiography. History of physician diagnosed hypertension, along with other medical characteristics, was ascertained through a review of participants' medical charts.. 69.8% of the HF patients had a diagnostic history of hypertension. After adjustment for demographic and medical characteristics (i.e., cardiac index, medication status, and resting blood pressure), hypertension was independently associated with attention/executive function/psychomotor speed (ΔF(1,103)=10.85, ΔR(2)=.07, p<.01) and motor functioning (ΔF(1,103)=4.46, ΔR(2)=.04, p<.05). HF patients with a diagnosed history of hypertension performed worse in these domains than those without such history.. The current findings indicate that diagnostic history of hypertension is an important contributor to cognitive impairment in HF. Hypertension frequently precedes HF and future studies should examine whether sustained hypertension compromises cerebral autoregulatory mechanisms to produce brain damage and exacerbate cognitive impairment in this population.

Topics: Aged; Aged, 80 and over; Attention; Cardiac Output; Cardiovascular Agents; Causality; Cognition Disorders; Comorbidity; Diabetes Mellitus; Executive Function; Female; Heart Failure; Humans; Hypertension; Language Disorders; Male; Memory Disorders; Middle Aged; Neuropsychological Tests; Psychomotor Performance; Time Factors

The efficacy of out-patient cardiac rehabilitation (OPCR) in patients with a low prognostic risk after acute myocardial infarction (AMI) is unclear in the recent primary intervention era.. A total of 637 AMI patients who participated in in-hospital cardiac rehabilitation were divided into 2 groups; low prognostic risk group (n=219; age <65 years, successful reperfusion, Killip class I, peak serum creatine kinase <6,000U/L, and left ventricular ejection fraction ≥40%) and non-low prognostic risk group (n=418). The prevalence of coronary risk factors (CRF) was compared between the 2 groups. Then, in the low-risk group, the efficacy of OPCR was compared between active OPCR participants (n=52; ≥20 sessions/3 months) and non-active participants (n=60; <6 sessions/3 months). Compared with the non-low prognostic risk group, the low prognostic risk group had a significantly higher prevalence of current smokers (72% vs. 49%, P<0.05) and patients with multiple CRF (3 or more; 49% vs. 39%, P<0.05). Among the low- risk group, active OPCR participants showed a significantly greater improvement in exercise capacity (peak VO(2), P<0.05) and maintained a better CRF profile (total cholesterol, triglyceride and blood pressure, all P<0.05) than inactive participants at 3 months.. Low prognostic risk AMI patients have a higher prevalence of multiple CRF than non-low risk patients. Even in this low risk group, active participation in OPCR is associated with improved exercise capacity and better CRF profile.

Topics: Ambulatory Care; Biomarkers; Cardiovascular Agents; Comorbidity; Creatine Kinase; Dyslipidemias; Exercise Test; Exercise Tolerance; Female; Humans; Hypertension; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Obesity; Prognosis; Retrospective Studies; Risk; Smoking; Stroke Volume; Treatment Outcome

Information relating the outcome of percutaneous coronary intervention to diabetes mellitus or hypertension is limited. The study objective was to describe the outcome in patients undergoing percutaneous coronary intervention in relation to diabetes and hypertension.. Data were extracted from 5 national registers: the Swedish Coronary Angiography and Angioplasty Register (all percutaneous coronary interventions), the Prescribed Drug Registry (all prescribed pharmaceuticals purchased in Swedish pharmacies), the Swedish Hospital Discharge Register (data on myocardial infarction, revascularization, stroke, and congestive heart failure from in-hospital and specialist health care), and the National Population Register and Cause of Death Register (data on death). We included all "first percutaneous coronary interventions" between January 1, 2006, and December 31, 2008 (n=44,268; followed an average of 1.9 [± 0.9] years).. Mortality was 6.4% and highest in patients with diabetes plus hypertension. Hypertension per se did not increase mortality or the risk for repeat intervention, but carried a 10% increased risk for subsequent myocardial infarction, increasing to a 4-fold increase when combined with diabetes. Stroke occurred in 2%; the importance of hypertension was evident in nondiabetic patients, but even stronger in diabetic patients. Congestive heart failure caused hospital admission in 8%, with a negative influence from hypertension with and without diabetes.. After percutaneous coronary intervention and with modern pharmacotherapy, diabetes had a negative effect on the outcome, especially when combined with hypertension. Hypertension per se was not associated with increased mortality but with an increased risk for myocardial infarction, stroke, and congestive heart failure, probably related to widespread coronary artery disease. Improved diabetes care might improve the prognosis.

Topics: Adult; Aged; Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Cardiovascular Diseases; Confounding Factors, Epidemiologic; Coronary Disease; Coronary Restenosis; Diabetes Complications; Diabetes Mellitus, Type 2; Female; Follow-Up Studies; Heart Failure; Humans; Hypertension; Hypoglycemic Agents; Male; Middle Aged; Myocardial Infarction; Prognosis; Registries; Retreatment; Stroke; Sweden; Treatment Outcome

Diabetic retinopathy is a microvascular complication of diabetes mellitus whose prevalence is closely related to the presence of nephropathy and hypertension. The aim was to study clinical and pharmacological factors that are associated with an increased need for laser photocoagulation in patients with diabetic nephropathy and retinopathy.. Cross sectional study of 63 patients followed in the Diabetic Nephropathy consultation. Patients were divided into 2 groups according to whether or not previously have received photocoagulation. In each subgroup were studied demographic variables, anthropometric, laboratory, cardiovascular risk factors and treatment received by each patient for the control of hypertension, diabetes and others diseases.. We observed that the group had received photocoagulation had more years of diabetes evolution, more history of cardiovascular disease and a lower creatinine clearance. Similarly, the percentage of patients treated with carvedilol was significantly higher in the subgroup who had not received photocoagulation while the percentage of patients treated with beta-blockers was significantly higher in the subgroup that received photocoagulation; no significant differences was observed in the degree of control blood pressure.. Clinical and pharmacological factors related to the requirements of laser photocoagulation were years of diabetes evolution, history of cardiovascular disease, the stage of kidney disease and the treatment with beta-blockers.

Topics: Aged; Antihypertensive Agents; Atherosclerosis; Cardiovascular Agents; Cardiovascular Diseases; Comorbidity; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Diabetic Retinopathy; Female; Humans; Hyperlipidemias; Hypertension; Hypoglycemic Agents; Hypolipidemic Agents; Insulin; Laser Coagulation; Male; Middle Aged; Recurrence; Risk Factors; Smoking

Topics: Atherosclerosis; Cardiovascular Agents; Disease Progression; Endovascular Procedures; Evidence-Based Medicine; Humans; Hypertension; Patient Selection; Randomized Controlled Trials as Topic; Renal Artery Obstruction; Renal Insufficiency; Risk Assessment; Risk Factors; Stents; Treatment Outcome; Vascular Surgical Procedures

Hypertension is a well established risk factor for the development of cardiovascular diseases and increased mortality. This study was performed to investigate the effects of the administration of L-carnitine or mildronate, an inhibitor of L-carnitine biosynthesis, or their combination on the development of hypertension-related complications in Dahl salt-sensitive (DS) rats fed with a high salt diet. Male DS rats were fed laboratory chow containing 8% NaCl from 7 weeks of age. Experimental animals were divided into five groups and treated for 8 weeks with vehicle (water; n = 10), L-carnitine (100 mg/kg, n = 10), mildronate (100 mg/kg, n = 10) or a combination of L-carnitine and mildronate at the doses above (n = 10). During the experiment, control group animals continued to consume a diet with normal salt content. Administration of the combination significantly improved the survival rate for 50% of the population. None of the tested compounds or their combination influenced high salt intake-induced hypertension, while treatment with mildronate and the combination for 8 weeks significantly decreased resting heart rate by 12% and 10%, respectively. Feeding with high salt diet had no influence on systolic function of the heart, but it induced thickening of the ventricular walls and development of heart hypertrophy that was not improved by the administration of tested compounds. In addition, administration of the combination attenuated the development of endothelial dysfunction in isolated aortic rings. In conclusion, our results demonstrate that treatment with a combination of L-carnitine and mildronate is protective against hypertension-induced complications in an experimental model of salt-induced hypertension.

Topics: Animals; Cardiovascular Agents; Carnitine; Endothelium, Vascular; Hypertension; Male; Methylhydrazines; Rats; Rats, Inbred Dahl; Sodium Chloride, Dietary; Survival Rate; Vitamin B Complex

Topics: Abortion, Induced; Aortic Diseases; Cardiovascular Agents; Contraindications; Counseling; Female; Heart Diseases; Humans; Hypertension; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Complications, Infectious; Prenatal Care; Prenatal Diagnosis; Venous Thromboembolism

Treatment of patients with hypertension and ischemic heart disease should be focused not only on the control of overall cardiovascular risk factors, particularly blood pressure, but also on eliminating anginal symptoms, or at least reducing them, as angina symptoms have a crucial prognostic value. Although the amount of blood pressure reduction, rather than the choice of antihypertensive drug, is the major determinant of reduction of cardiovascular risk, some drugs such as ?-blockers should be preferably used in patients with angina. However, ?-blockers are contraindicated or produce intolerable side effects in many patients. Although, in the last years, new drugs for the treatment of stable angina have emerged, diltiazem should remain as a good alternative in the treatment of these patients. In this article, available evidence regarding diltiazem in the treatment of hypertension and ischemic heart disease is updated.

Topics: Antihypertensive Agents; Blood Pressure; Cardiovascular Agents; Cardiovascular Diseases; Diltiazem; Humans; Hypertension; Myocardial Ischemia; Risk Factors

Assessing the medical history of patients before any treatment is an essential aspect of the dentist's responsibility; however, many dental practitioners assume that their patients are systemically healthy so their medical history is often overlooked. The objective of this study was to determine the prevalence of self-reported medical conditions among a sample of dental school patients at the Institute of Dental Sciences, Bareilly (Uttar Pradesh), India. Detailed medical histories were taken from 3,786 new dental patients in an outpatient setting. The demographic data, medical status, and use of medications from the charts were analyzed. Thirty-eight percent of the total patients had a positive finding in their medical history for at least one systemic condition. The most commonly reported systemic condition was hypertension (15.2 percent) followed by diabetes (11.4 percent), and 26 percent of the patients were taking at least one medication daily. The results of this study reflect the medical complexity of the increasingly aging population.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Analgesics; Antihypertensive Agents; Cardiovascular Agents; Chronic Disease; Dental Care; Diabetes Mellitus; Drug Hypersensitivity; Female; Health Status; Humans; Hypertension; Hypolipidemic Agents; India; Male; Medical History Taking; Middle Aged; Platelet Aggregation Inhibitors; Prevalence; Prospective Studies; Self Report; Vitamins; Young Adult

Elevated catecholamine levels are a well-recognized cause of various types of cardiomyopathy. Causes of catecholamine elevation include tumors, toxins, drugs, emotional stress, and sepsis. Milnacipran is a dual and equipotent inhibitor of norepinephrine and serotonin uptake. It is frequently prescribed as therapy for fibromyalgia, and the drug has a good safety profile. Herein, we report the case of a 42-year-old woman with undefined connective-tissue disease and fibromyalgia who developed a severe and reversible cardiomyopathy while taking recommended doses of milnacipran. The cardiomyopathy was associated with a hyperadrenergic state manifested by tachycardia, hypertension, and elevated plasma catecholamine levels. The discontinuation of milnacipran and the initiation of anti-failure therapy resulted in complete resolution of the cardiomyopathy in 6 months. To our knowledge, this is the first report of milnacipran as a possible cause of catecholamine-induced cardiomyopathy.

Topics: Adrenergic Uptake Inhibitors; Adult; Cardiomyopathies; Cardiovascular Agents; Catecholamines; Coronary Angiography; Cyclopropanes; Female; Humans; Hypertension; Magnetic Resonance Imaging; Milnacipran; Selective Serotonin Reuptake Inhibitors; Tachycardia; Time Factors; Treatment Outcome; Up-Regulation

Ample research has examined physicians' evidence-based medicine (EBM) knowledge and skills; however, previous research has not linked EBM knowledge to objective measures of process of care.. A cross-sectional study of quality of care measures extracted from electronic medical records and EBM knowledge assessed via a validated questionnaire.. One region of the largest Health Maintenance Organization in Israel.. Seventy-four physicians and their 8334 diabetic patients, 7092 coronary heart disease patients and 17 132 hypertensive patients.. Outcome measures were four diabetes quality of care indicators (LDL tests, microalbumin tests, hemoglobin A1C tests, eye examination referrals), and two drug prescription indicators (statin prescription for coronary heart disease patients, and thiazide prescription for hypertensive patients). Independent variables were total EBM knowledge and its components: critical appraisal and information retrieval.. Total EBM knowledge was independently and significantly associated with LDL testing (b = 0.13; P = 0.036), microalbumin testing (b = 0.33; P = 0.001), hemoglobin A1C testing (b = 0.17; P = 0.036), eye examination referrals (b = 0.16; P = 0.021) and statin prescriptions (b = 0.18; P = 0.025). Critical appraisal was independently associated with microalbumin tests (b = 0.46; P = 0.002) and eye examination referrals (b = 0.20; P = 0.048). Information retrieval was only independently associated with hemoglobin A1C testing (b = 0.43; P = 0.004). Thiazide prescription was not associated with EBM knowledge scores.. Physicians' higher total EBM knowledge primarily correlates with better quality of care; however, correlations were modest and explained only a small portion in the variance of clinical performance. Results indicate that there might be a need to focus on teaching all the components of EBM rather than EBM microskills.

Topics: Adult; Cardiovascular Agents; Coronary Disease; Cross-Sectional Studies; Diabetes Mellitus; Drug Utilization; Evidence-Based Medicine; Female; Health Knowledge, Attitudes, Practice; Humans; Hypertension; Israel; Male; Middle Aged; Physicians, Family; Practice Patterns, Physicians'; Quality Indicators, Health Care; Quality of Health Care

reduced grip strength is associated with adverse health consequences, and there is interest in identifying modifiable influences. Cardiovascular drugs are commonly used by older people, but their effect on muscle strength is unclear.. we investigated associations between cardiovascular drug use and grip strength among 1,572 men and 1,415 women, aged 59-73, who participated in the Hertfordshire Cohort Study.. Forty-five percent of participants were taking a cardiovascular drug. Furosemide was associated with average decreases in grip strength of 3.15 kg (95% confidence interval [CI] 0.90, 5.39, P < 0.01) among men and 2.35 kg (95% CI 0.93, 3.77, P < 0.01) among women after adjustment for age and height. Corresponding differences for nitrates were 1.84 kg (95% CI 0.29, 3.39, P = 0.02) among men and 3.66 kg (95% CI 1.99, 5.33, P < 0.01) among women. Calcium channel blockers and fibrates were associated with reduced grip among women. Statins were not associated with grip. The associations between grip strength and nitrate use in men and nitrate and fibrate use in women were robust to additional adjustment for co-morbidity.. use of some cardiovascular drugs is associated with reduced grip strength in older people. These findings have potential implications for the functional ability of older people treated with these drugs.

Topics: Activities of Daily Living; Aged; Aging; Cardiovascular Agents; Cohort Studies; England; Female; Geriatric Assessment; Hand Strength; Humans; Hypertension; Male; Middle Aged; Muscle Strength; Muscle Strength Dynamometer; Sex Factors; Surveys and Questionnaires

The American Heart Association (AHA) Scientific Sessions 2009 meeting held in Orlando, FL, USA included topics covering new treatments for cardiovascular disease. This conference report highlights selected presentations on stem cell treatments for ischemia, treatments for hypertension and atherosclerosis, and LDL-lowering compounds.

Topics: Anticholesteremic Agents; Atherosclerosis; Cardiovascular Agents; Cardiovascular Diseases; Cholesterol, LDL; Humans; Hypertension; Myocardial Ischemia; Stem Cell Transplantation

The well known metabolic functions of L-arginine have been recently increased with the discovery of its role as the substrate for the synthesis of nitric oxide (NO), which has emerged as an endogenous signaling molecule with potential therapeutic implications for cardiovascular disease. Steady-state levels of NO are derived in part from dietary sources. It has been reported that supplementation of L-arginine reduces atherosclerosis in rabbits and reduces the arterial pressure in hypertensive rats. Therefore, we investigated the effect of L-arginine supplementation using a group of induced hypercholesterolemic rats and a group of spontaneously hypertensive rats; the infarcted area in cardiac tissue of both groups was measured during the response to myocardial infarction in the ischemia-reperfusion model. Hypercholesterolemic rats supplemented with 170 mg kg(-1) of L-arginine showed a significant (P

Topics: Administration, Oral; Animals; Arginine; Blood Pressure; Cardiovascular Agents; Dietary Supplements; Hypercholesterolemia; Hypertension; Male; Myocardial Infarction; Myocardium; Nitric Oxide; Random Allocation; Rats; Rats, Inbred SHR; Rats, Inbred WKY

We have demonstrated previously that both acute and chronic oral administration of adenosine have novel functions such as anti-hypertensive effects and improved hyperlipidaemia in stroke-prone spontaneously hypertensive rats (SHRSP) fed a normal diet. The purpose of the present study was to investigate the effect of adenosine administration on metabolic syndrome-related parameters in SHRSP fed a high-fat diet. Six-week-old rats were divided into three groups, and were administered either water (control) or adenosine (10 or 100 mg/l) for 8 weeks. During this period, the rats had free access to a high-fat diet based on AIN-93M. The results showed that hypertension, plasma lipid, NO, insulin, glucose and urinary 8-hydroxy-2'-deoxyguanosine levels improved significantly in both adenosine groups. The mRNA expression levels of genes involved in anti-oxidative activity and adenosine receptors were also altered in the adenosine groups. Administration of adenosine also increased plasma adiponectin levels, accompanied by upregulation of mRNA expression level of adiponectin and adiponectin receptor 1 in perirenal fat and adiponectin receptor 2 in the liver. In conclusion, oral administration of adenosine is effective for improving metabolic syndrome-related parameters in SHRSP, and accordingly it may prevent the progression of the metabolic syndrome.

Topics: 8-Hydroxy-2'-Deoxyguanosine; Adenosine; Adiponectin; Adipose Tissue; Animals; Antioxidants; Blood Glucose; Cardiovascular Agents; Deoxyguanosine; Dietary Fats; Enzymes; Gene Expression; Gene Expression Regulation; Hypertension; Insulin; Kidney; Lipids; Liver; Male; Metabolic Syndrome; Nitric Oxide; Rats; Rats, Inbred SHR; Receptors, Adiponectin; RNA, Messenger; Stroke

Growing evidence suggests that arginase misregulation plays a key role in the pathophysiology of essential hypertension. In the present study, we investigated the potential cardiovascular therapeutic effects of a long-term treatment with an arginase inhibitor in adult spontaneously hypertensive rats (SHR) with fully developed hypertension.. Treatment of 25-week-old SHR with the arginase inhibitor N(omega)-hydroxy-nor-L-arginine (nor-NOHA, 40 mg/day for 10 weeks) sustainably reduced systolic blood pressure (-30 mmHg, P < 0.05). The antihypertensive effect of nor-NOHA was associated with changes on mesenteric artery reactivity including the restoration of angiotensin-II-induced contraction and acetylcholine-induced vasodilation to the values of normotensive Wistar Kyoto rats. Both nitric oxide synthase and cyclooxygenase-dependent mechanisms account for the improvement of endothelial function afforded by the arginase inhibitor, which in addition blunted hypertension-induced endothelial arginase I overexpression in mesenteric arteries. Nor-NOHA also prevented the remodelling of aorta as measured by collagen content and media/lumen ratio, and improved the compliance of carotid artery in SHR. Cardiac fibrosis assessed by collagen content of left heart ventricle was reduced by nor-NOHA, with no significant effect on cardiac hypertrophy.. Our results report that a long-term treatment with an arginase inhibitor reduced blood pressure, improved vascular function, and reduced cardiac fibrosis in SHR with fully developed hypertension. These data suggest that arginase represents a promising novel target for pharmacological intervention in essential hypertension.

Topics: Animals; Aorta; Arginase; Arginine; Blood Pressure; Cardiovascular Agents; Carotid Arteries; Collagen; Compliance; Cyclooxygenase 1; Cyclooxygenase 2; Disease Models, Animal; Dose-Response Relationship, Drug; Endothelium, Vascular; Enzyme Inhibitors; Fibrosis; Heart Diseases; Hypertension; Male; Membrane Proteins; Mesenteric Arteries; Myocardium; Nitric Oxide Synthase; Rats; Rats, Inbred SHR; Rats, Inbred WKY; Time Factors; Vasoconstriction; Vasoconstrictor Agents; Vasodilation; Vasodilator Agents

Cigarette smoking, raised blood pressure, unfavourable lipid concentrations, diabetes and - more indirectly - obesity, are responsible for most coronary heart disease events in developed and developing countries.. The objective of our study was to compare prevalence, treatment and control of cardiovascular risk factors in two samples of men with stable coronary heart disease, recruited in France and Spain.. Standardized measurements of body mass index, systolic and diastolic blood pressures, plasma lipids, glycaemia, and smoking were collected and drug use was registered. Cross-sectional comparisons were made between French and Spanish samples.. Data from 982 individuals were analysed (420 French and 562 Spanish men). Current smoking was more frequent in Spain (p<0.001), whereas hypertension and uncontrolled blood pressure were more frequent in France (p<0.001). Mean concentrations of low-density lipoprotein cholesterol and triglycerides were significantly higher in France (p<0.001). No significant differences were observed regarding obesity, high-density lipoprotein cholesterol and diabetes. More than 97% of participants presented with at least one of the following conditions: hypertension, dyslipidaemia, diabetes, obesity or smoking. Antiplatelet agents, calcium inhibitors, diuretics and hypoglycaemic drugs were used more frequently in France, whereas angiotensin-converting enzyme inhibitors and lipid-lowering treatments were used more frequently in Spain.. Prevalence of cardiovascular risk factors is high among French and Spanish patients with stable coronary heart disease, with differences between countries regarding the distribution of the various risk factors. A great proportion of patients do not reach the recommended levels for risk factor control.

Topics: Aged; Cardiovascular Agents; Cardiovascular Diseases; Chi-Square Distribution; Coronary Disease; Cross-Sectional Studies; Diabetes Mellitus; Dyslipidemias; France; Health Status Disparities; Healthcare Disparities; Humans; Hypertension; Male; Middle Aged; Obesity; Prevalence; Registries; Risk Assessment; Risk Factors; Smoking; Spain; Time Factors

To assess the impact of chronic renal insufficiency (CRI) on in-hospital major adverse cardiac events across the acute coronary syndrome (ACS) spectrum.. From January 29, 2007, through July 29, 2007, 6 adjacent Middle Eastern countries participated in the Gulf Registry of Acute Coronary Events, a prospective, observational registry of 8176 patients. Patients were categorized according to estimated glomerular filtration rate into 4 groups: normal (>or=90 mL/min), mild (60-89 mL/min), moderate (30-59 mL/min), and severe CRI (<30 mL/min). Patients' characteristics and in-hospital major adverse cardiac events in the 4 groups were analyzed.. Of 6518 consecutive patients with ACS, 2828 (43%) had mild CRI, 1304 (20%) had moderate CRI, and 345 (5%) had severe CRI. In CRI groups, patients were older and had a higher prevalence of hypertension, diabetes mellitus, and dyslipidemia. On admission, these patients had a higher resting heart rate and frequently had atypical and delayed presentations. Compared with the normal estimated glomerular filtration group, CRI groups were less likely to receive antiplatelet drugs, beta-blockers, angiotensin-converting enzyme inhibitors, and statins and were less likely to undergo coronary angiography. In-hospital heart failure, cardiogenic shock, and major bleeding episodes were significantly higher in all CRI groups. In multivariate analysis, mild, moderate, and severe CRI were associated with a higher adjusted odds ratio (OR) of death (mild: OR, 2.1; 95% confidence interval [CI], 1.2-3.7; moderate: OR, 6.7; 95% CI, 3.9-11.5; and severe: OR, 12.0; 95% CI, 6.6-21.7).. Across the ACS spectrum, patients with CRI had a worse risk profile, had more atypical and delayed presentations, and were less likely to receive evidence-based therapy. Chronic renal insufficiency of varying stages is an independent predictor of in-hospital morbidity and mortality.

Topics: Acute Coronary Syndrome; Adrenergic beta-Antagonists; Adult; Aged; Angiotensin-Converting Enzyme Inhibitors; Cardiovascular Agents; Chi-Square Distribution; Comorbidity; Diabetes Mellitus; Dyslipidemias; Female; Glomerular Filtration Rate; Humans; Hypertension; Kidney Failure, Chronic; Length of Stay; Male; Middle Aged; Middle East; Outcome Assessment, Health Care; Patient Admission; Registries; Risk Factors; Severity of Illness Index; Survival Analysis; Treatment Outcome

We sought to explore new strategies targeting SUR2B/Kir6.1, a subtype of adenosine triphosphate (ATP)-sensitive potassium channels (KATP), against pressure overload-induced heart failure. The effects of natakalim, a SUR2B/Kir6.1 selective channel opener, on progression of cardiac remodeling were investigated. Pressure overload-induced heart failure was induced in Wistar rats by abdominal aortic banding. The effects of natakalim (1, 3, and 9 mg·kg⁻¹·d⁻¹ for 10 weeks) on myocardial hypertrophy and heart failure, cardiac histology, vasoactive compounds, and gene expression were assessed. Ten weeks after the onset of pressure overload, natakalim treatment potently inhibited cardiac hypertrophy and prevented heart failure. Natakalim remarkably inhibited the changes of left ventricular hemodynamic parameters and reversed the increase of heart mass index, left ventricular weight index, and lung weight index. Histological examination demonstrated that there was no significant hypertrophy or fibrosis in pressure-overloaded hearts of natakalim-treated rats. Ultrastructural examination of hearts revealed well-organized myofibrils with mitochondria grouped along the periphery of longitudinally oriented fibers in rats from the natakalim group. The content of serum nitric oxide and plasma prostacyclin was increased, whereas that of plasma endothelin-1 and cardiac tissue hydroxyproline and atrial and B-type natriuretic peptide messenger RNA was downregulated in natakalim-treated rats. Natakalim at 0.01-100 µM had no effects on isolated working hearts derived from Wistar rats; however, natakalim had endothelium-dependent vasodilatory effects on the isolated tail artery helical strips precontracted with norepinephrine. These results indicate that natakalim reduces heart failure caused by pressure overloading by activating the SUR2B/Kir6.1 KATP channel subtype and protecting against endothelial dysfunction.

Topics: Allyl Compounds; Animals; ATP-Binding Cassette Transporters; Blood Pressure; Cardiomegaly; Cardiovascular Agents; Dose-Response Relationship, Drug; Endothelial Cells; Endothelin-1; Endothelium, Vascular; Epoprostenol; Heart Failure; Hypertension; In Vitro Techniques; KATP Channels; Male; Myocardium; Nitric Oxide; Potassium Channels, Inwardly Rectifying; Propylamines; Rats; Rats, Wistar; Receptors, Drug; Sulfonylurea Receptors; Tail; Vasodilator Agents; Ventricular Remodeling

Myocardial hypertrophy has been recognized to be an adaptive response to a variety of external stimuli (e.g., myocardial infarction, pressure overload, catecholamine treatment, endocrine disorders) that are involved in several subcellular factors that mediate signaling pathways, from external stimuli to nuclear protein synthesis. Glycogen synthase kinase-3beta (GSK-3beta) is one of the subcellular factors that regulate nuclear transcription factors, such as activated T-cell (NFAT) proteins, that are related to gene programming during cardiac hypertrophy. On the other hand, GSK-3beta, known as a regulator of cardiomyocyte growth in Wnt signaling of cardiogenesis, is involved in beta-catenin degradation. Inhibition of GSK-3beta has been reported to induce cardiac hypertrophy. Tateishi et al. demonstrated in an aortic constriction-induced acute hypertrophy model using 6-week-old Wister rats that if GSK-3b is inhibited by LiCl up-regulated beta-catenin expression and additional hypertrophy were observed. They suggested that Li(2+) had an additive effect on pressure overload-induced hypertrophy through the GSK-3beta-beta-catenin pathway. Their article provides promising information on the mechanism of hypertrophic myocyte growth during acute pressure overload.

Topics: Animals; Aorta, Abdominal; Atrial Natriuretic Factor; beta Catenin; Blood Pressure; Cardiovascular Agents; Disease Models, Animal; Glycogen Synthase Kinase 3; Glycogen Synthase Kinase 3 beta; Hypertension; Hypertrophy, Left Ventricular; Ligation; Lithium Chloride; Phosphorylation; Protein Kinase Inhibitors; Rats; RNA, Messenger; Serine; Time Factors

A large number of diverse signaling molecules in cell and animal models participate in the stimulus-response pathway through which the hypertrophic growth of the myocardium is controlled. However, the mechanisms of signaling pathway including the influence of lithium, which is known as an inhibitor of glycogen synthase kinase-3beta, in pressure overload hypertrophy remain unclear. The aim of our study was to determine whether glycogen synthase kinase-3beta inhibition by lithium has acute effects on the myocyte growth mechanism in a pressure overload rat model.. First, we created a rat model of acute pressure overload cardiac hypertrophy by abdominal aortic banding. Protein expression time courses for beta-catenin, glycogen synthase kinase-3beta, and phosphoserine9-glycogen synthase kinase-3beta were then examined. The rats were divided into four groups: normal rats with or without lithium administration and pressure-overloaded rats with or without lithium administration. Two days after surgery, Western blot analysis of beta-catenin, echo-cardiographic evaluation, left ventricular (LV) weight, and LV atrial natriuretic peptide mRNA levels were evaluated.. We observed an increase in the level of glycogen synthase kinase-3beta phosphorylation on Ser 9. A significant enhancement of LV heart weight (P < 0.05) and interventricular septum and posterior wall thickness (P < 0.05) with pressure-overloaded hypertrophy in animals treated with lithium were also observed. Atrial natriuretic peptide mRNA levels were significantly increased with pressure overload hypertrophy in animals treated with lithium.. We have shown in an animal model that inhibition of glycogen synthase kinase-3beta by lithium has an additive effect on pressure overload cardiac hypertrophy.

Topics: Animals; Aorta, Abdominal; Atrial Natriuretic Factor; beta Catenin; Blood Pressure; Blotting, Western; Cardiovascular Agents; Disease Models, Animal; Glycogen Synthase Kinase 3; Glycogen Synthase Kinase 3 beta; Hypertension; Hypertrophy, Left Ventricular; Ligation; Lithium Chloride; Male; Phosphorylation; Polymerase Chain Reaction; Protein Kinase Inhibitors; Rats; Rats, Wistar; RNA, Messenger; Serine; Time Factors; Ultrasonography

Topics: Blood Glucose; Cardiovascular Agents; Diabetes Mellitus; Humans; Hypertension; Randomized Controlled Trials as Topic; Risk Assessment; Sodium Chloride Symporter Inhibitors; Thiazides

The aim of this work was to determine the frequency and nature of oral manifestations secondary to use of cardiovascular drugs.. Five hundred and thirty one patients attending an adult cardiology clinic in Saudi Arabia were questioned about the occurrence of oral dryness, dysgeusia, or burning sensation and were clinically evaluated for the presence of oral mucosal or gingival disease. Data were statistically analyzed with chi-squared tests, odds ratios and Student's t-test.. Oral symptoms and/or signs were recorded in 75 (14.1%) patients with xerostomia being the most common (7.5%), followed by lichenoid (lichen planus-like) lesions (3.6%) and dysgeusia (1.9%). Xerostomia was significantly more frequent in patients with a history of diabetes mellitus and in female patients (P < 0.05). There were no statistically significant differences (P > 0.05) between patients with or without oral manifestations when age, gender, cardiovascular risk factor, cardiac disease, type of cardiac drug used or the number of medications were assessed. There was a trend for xerostomia to be less frequent in patients receiving therapy with angiotensin converting enzyme inhibitors and a slight trend of xerostomia to be more likely with increased number of non-cardiac and total number of agents per subject. The number of non-cardiac and total medications taken by patients with potential oral manifestations tended to be greater than that of patients without oral manifestations.. The frequency of potential oral manifestations in patients receiving cardiovascular agents was 14.1%. The occurrence and character of the oral manifestations had no significant relation with individual cardiac drugs, although there was a trend for oral manifestations to be likely with increasing number of drugs.

Topics: Adolescent; Adrenergic alpha-Antagonists; Adrenergic beta-Antagonists; Adult; Aged; Aged, 80 and over; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Calcium Channel Blockers; Cardiovascular Agents; Cohort Studies; Coronary Artery Disease; Diabetes Complications; Diuretics; Dysgeusia; Female; Gingival Diseases; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypertension; Lichenoid Eruptions; Male; Middle Aged; Mouth Diseases; Paresthesia; Platelet Aggregation Inhibitors; Vasodilator Agents; Xerostomia; Young Adult

To compare gender-related lifestyle changes and risk factor management after hospitalisation for a coronary event or revascularisation intervention in Europe.. The EUROASPIRE III survey was carried out in 22 European countries in 2006-2007. Consecutive patients having had a coronary event or revascularisation before the age of 80 were identified. A total of 8966 patients (25.3% women) were interviewed and underwent clinical and biochemical tests at least 6 months after hospital admission. Trends in cardiovascular risk management were assessed on the basis of the 1994-1995, 1999-2000 and 2006-2007 EUROASPIRE surveys.. Female survey participants were generally older and had a lower educational level than male participants (p<0.0001). The prevalences of obesity (p<0.0001), high blood pressure (BP) (p=0.001), elevated low-density lipoprotein (LDL)-cholesterol (p<0.0001) and diabetes (p<0.0001) were significantly higher in women than in men, whereas current smoking (p<0.0001) was significantly more common in men. The use of antihypertensive and antidiabetic drugs (but not that of other drugs) was more common in women than in men. However, BP (p<0.0001), LDL-cholesterol (p<0.0001) and HbA1c (p<0.0001) targets were less often achieved in women than in men. Between 1994 and 2007, cholesterol control improved less in women than in men (interaction: p=0.009), whereas trends in BP control (p=0.32) and glycaemia (p=0.36) were similar for both genders.. The EUROASPIRE III results show that despite similarities in medication exposure, women are less likely than men to achieve BP, LDL-cholesterol and HbA1c targets after a coronary event. This gap did not appear to narrow between 1994 and 2007.

Topics: Adolescent; Adult; Age Factors; Aged; Cardiovascular Agents; Cardiovascular Diseases; Coronary Disease; Diabetes Complications; Educational Status; Europe; Female; Health Care Surveys; Humans; Hypercholesterolemia; Hypertension; Life Style; Male; Middle Aged; Obesity; Risk Factors; Sex Factors; Smoking Cessation; Young Adult

The profile of recurrent ischemic strokes has not been much investigated. The aim of this study was to evaluate how the therapeutic strategies recommended for secondary prevention after an ischemic stroke are implemented in the real world of clinical practice. All patients admitted for a recurrent ischemic stroke or TIA were prospectively registered. The etiology was determined according to the TOAST classification. The risk factors and cardiovascular treatment at the time of the recurrence were recorded. A total of 168 patients were evaluated. Most of the patients (61%) recurred after 1 year. The recurrent stroke was not associated with a particular etiological subtype. The most frequent risk factor was hypertension (79%), followed by hypercholesterolemia (43%), smoking (25%), and diabetes (22%). Most of the patients had more than 1 risk factor (84%). Hypertension was not satisfactorily controlled in 38% of patients, hypercholesterolemia in 42%, and diabetes in 59%. A significant minority of patients (15%) were not taking any antithrombotic agent despite a history of stroke or TIA. Only 34% of the cases with a known atrial fibrillation were on anticoagulant therapy and the International Normalized Ratio was < 2.0 in 71% of them. In conclusion, stroke prevention needs to be improved by better implementation of therapeutic strategies in clinical practice. The patients should also be better informed about target values as well as the importance of physical activity and smoking cessation.

Topics: Adult; Aged; Aged, 80 and over; Cardiovascular Agents; Diabetes Complications; Female; Humans; Hyperlipidemias; Hypertension; Male; Middle Aged; Retrospective Studies; Risk Assessment; Risk Factors; Secondary Prevention; Smoking; Stroke; Young Adult

Atherosclerosis begins in childhood with fatty streaks, which progress seamlessly to fibrous plaques in adulthood. These plaques, in turn, might rupture and cause thrombotic arterial occlusion and ischemic damage to vital organs. The earliest stages and progression of atherosclerosis in youth are influenced by the same major established risk factors for this condition in adults-dyslipidemia, hypertension, smoking, obesity, and diabetes mellitus. Controlling these risk factors at any age is beneficial, but the earlier primary prevention begins, the better the result. As recommended by the American Academy of Pediatrics, pediatricians should support both control and prevention of these risk factors in children via lifestyle modification. Drug treatment can be used to supplement lifestyle modification in the few cases of children with genetic dyslipidemias who do not respond to diet changes. Ultimately, however, effective prevention of adult disease requires a massive cultural change.

Topics: Adolescent; Adult; Atherosclerosis; Cardiology; Cardiovascular Agents; Cardiovascular Diseases; Diabetes Complications; Disease Progression; Dyslipidemias; Humans; Hypertension; Pediatrics; Physician's Role; Practice Guidelines as Topic; Primary Prevention; Risk Factors; Risk Reduction Behavior; Smoking; Societies, Medical; United States; Young Adult

We investigated whether P144, a synthetic peptide from transforming growth factor-beta(1) (TGF-beta(1)) type III receptor betaglycan, exhibits cardiac antifibrotic properties.. The study was carried out in one group of 10-week-old normotensive Wistar-Kyoto rats treated with vehicle (V-WKY), one group of 10-week-old spontaneously hypertensive rats treated with vehicle (V-SHR), and one group of 10-week-old SHR treated with P144 (P144-SHR) for 12 weeks. Two more groups of 10-week-old untreated WKY and SHR were used to assess baseline values of the parameters tested. In addition, the effects of P144 on rat cardiac fibroblasts stimulated with TGF-beta(1) were also studied. Compared with V-WKY, V-SHR exhibited significant increases in the myocardial expression of phosphorylated Smad2, 38 and 42 kDa connective tissue growth factor (CTGF) isoforms, procollagen alpha1 (I) mRNA, and collagen type I protein, as well as in the expression of lysyl oxidase (LOX) mRNA and protein, collagen cross-linking and deposition. P144 administration was associated with significant reduction in all these parameters in P144-SHR. TGF-beta(1)-stimulated fibroblasts exhibited significant increases in phosphorylated Smad2, 38 and 42 kDa CTGF proteins, and procollagen alpha(1) (I) mRNA compared with control fibroblasts. No significant differences were found in these parameters between fibroblasts incubated with TGF-beta(1) and P144 and control fibroblasts.. These results show that P144 inhibits TGF-beta(1)-dependent signalling pathway and collagen type I synthesis in cardiac fibroblasts. These effects may be involved in the ability of this peptide to prevent myocardial fibrosis in SHR.

Topics: Animals; Blood Pressure; Cardiomyopathies; Cardiovascular Agents; Cell Line; Collagen Type I; Collagen Type I, alpha 1 Chain; Connective Tissue Growth Factor; Disease Models, Animal; Fibroblasts; Fibrosis; Hypertension; Injections, Intraperitoneal; Male; Myocardium; Peptide Fragments; Protein-Lysine 6-Oxidase; Proteoglycans; Rats; Rats, Inbred SHR; Rats, Inbred WKY; Receptors, Transforming Growth Factor beta; RNA, Messenger; Signal Transduction; Smad2 Protein; Transforming Growth Factor beta1

Topics: Adrenalectomy; Aldosterone; Animals; Antihypertensive Agents; Cardiovascular Agents; Cardiovascular Diseases; Humans; Hyperaldosteronism; Hypertension; Mineralocorticoid Receptor Antagonists

Over many decades, several attempts have been made to treat hypertension using a vaccination strategy to inhibit the renin-angiotensin system. Renin vaccination successfully inhibited renin activity and reduced blood pressure in animal models, but caused autoimmune disease of the kidney. By contrast, most previous studies of angiotensin vaccination failed to reduce blood pressure in animal models, despite producing high titers of antibodies that prevented the pressor response to exogenous angiotensins. Angiotensin vaccination is being revisited as a strategy for treating hypertension, in the hope that new conjugates of angiotensin I and angiotensin II will produce antibodies of sufficient titer and affinity to reduce blood pressure in patients with hypertension. A recent clinical study of angiotensin II vaccination provided some cause for optimism, but many hurdles remain before this strategy can compete with current oral medications for hypertension.

Topics: Angiotensins; Animals; Cardiovascular Agents; Disease Models, Animal; Humans; Hypertension; Renin-Angiotensin System; Vaccines

We investigated the effects of iptakalim, a new ATP-sensitive potassium channel (K(ATP)) opener providing endothelial protection, on the progression of cardiac hypertrophy to failure in a rat model of pressure overloading caused by abdominal aortic banding (AAB). Endothelial dysfunction is central to cardiac hypertrophy and failure induced by pressure overload. It would be useful to clarify whether iptakalim could prevent this.. The effects of pressure overload were assessed in male Sprague-Dawley rats 6 weeks after AAB using progression of cardiac hypertrophy to heart failure as the endpoint. The AAB-treated rats had significantly elevated blood pressure, systolic and diastolic cardiac dysfunction, evidence of left ventricular hypertrophy (LVH), and transition to heart failure. LVH was characterized by increases in the ratios of heart and left ventricular weights to body weight, increased myocyte cross-sectional areas, myocardial and perivascular fibrosis, and elevated cardiac hydroxyproline. These could be prevented by treatment with iptakalim at daily oral doses of 1, 3, and 9 mg/kg for 6 weeks. Progression to cardiac failure, demonstrated by increases in relative lung and right ventricular weights, cardiac function disorders and overexpression of atrial and B-type natriuretic peptide mRNA, could also be prevented. The downregulated nitric oxide signalling system was enhanced, whereas the upregulated endothelin signalling system was inhibited, resulting in normalization of the balance between these two systems.. Iptakalim protected the endothelium and prevented progression of cardiac hypertrophy to failure induced by a pressure overload.

Topics: Animals; Aorta, Abdominal; Atrial Natriuretic Factor; Blood Pressure; Cardiovascular Agents; Disease Models, Animal; Disease Progression; Dose-Response Relationship, Drug; Endothelin-1; Endothelium, Vascular; Fibrosis; Heart Failure; Heart Rate; Hydroxyproline; Hypertension; Hypertrophy, Left Ventricular; KATP Channels; Male; Myocardium; Natriuretic Peptide, Brain; Nitric Oxide; Propylamines; Rats; Rats, Sprague-Dawley; Signal Transduction; Time Factors; Ventricular Remodeling

Oxidative stress followed by abnormal signalling can play a critical role in the development of long-term, high blood pressure-induced cardiac remodelling in heart failure (HF). Since oxidative stress-induced poly(ADP-ribose)polymerase (PARP) activation and cell death have been observed in several experimental models, we investigated the possibility that inhibition of nuclear PARP improves cardiac performance and delays transition from hypertensive cardiopathy to HF in a spontaneously hypertensive rat (SHR) model of HF.. SHRs were divided into two groups: one received no treatment (SHR-C) and the other (SHR-L) received 5 mg/kg/day L-2286 (PARP-inhibitor) orally for 46 weeks. A third group was a normotensive age-matched control group (CFY) and a fourth was a normotensive age-matched group receiving L-2286 treatment 5 mg/kg/day (CFY+L). At the beginning of the study, systolic function was similar in both CFY and SHR groups. In the SHR-C group at the end of the study, eccentric hypertrophy with poor left ventricular (LV) systolic function was observed, while PARP inhibitor treatment preserved systolic LV function. Due to these favourable changes, the survival rate of SHRs was significantly improved (P < 0.01) by the administration of the PARP inhibitor (L-2286). The PARP inhibitor used did not affect the elevated blood pressure of SHR rats, but moderated the level of plasma-BNP (P < 0.01) and favourably influenced all the measured gravimetric parameters (P < 0.05) and the extent of myocardial fibrosis (P < 0.05). The inhibition of PARP increased the phosporylation of Akt-1/GSK-3beta (P < 0.01), ERK 1/2 (P < 0.01), and PKC epsilon (P < 0.01), and decreased the phosphorylation of JNK (P < 0.05), p-38 MAPK (P < 0.01), PKC pan betaII and PKC zeta/lambda (P < 0.01), and PKC alpha/betaII and delta (P < 0.05).. These data demonstrate that chronic inhibition of PARP induces long-term favourable changes in the most important signalling pathways related to oxidative stress. PARP inhibition also prevents remodelling, preserves systolic function, and delays transition of hypertensive cardiopathy to HF in SHRs.

Topics: Administration, Oral; Animals; Blood Pressure; Cardiovascular Agents; Disease Models, Animal; Disease Progression; Enzyme Inhibitors; Extracellular Signal-Regulated MAP Kinases; Fibrosis; Glycogen Synthase Kinase 3; Glycogen Synthase Kinase 3 beta; Heart Failure; Hypertension; Hypertrophy, Left Ventricular; Isoenzymes; JNK Mitogen-Activated Protein Kinases; Male; Myocardium; Natriuretic Peptide, Brain; Oxidative Stress; p38 Mitogen-Activated Protein Kinases; Phosphorylation; Piperidines; Poly (ADP-Ribose) Polymerase-1; Poly(ADP-ribose) Polymerase Inhibitors; Poly(ADP-ribose) Polymerases; Protein Kinase C; Proto-Oncogene Proteins c-akt; Quinazolines; Rats; Rats, Inbred SHR; Signal Transduction; Time Factors; Ventricular Function, Left; Ventricular Remodeling

Topics: Animals; Cardiovascular Agents; Disease Progression; Endothelin-1; Endothelium, Vascular; Fibrosis; Heart Failure; Hemodynamics; Humans; Hypertension; Hypertrophy, Left Ventricular; KATP Channels; Mice; Myocardium; Nitric Oxide; Propylamines; Signal Transduction; Ventricular Remodeling

Limited contemporary data exist on the cardiovascular risk of patients with prior coronary artery bypass grafting surgery (CABG) requiring diagnostic coronary angiography. We examined the prevalence and control of coronary artery disease risk factors and the outcomes of 367 prior CABG patients who underwent diagnostic coronary angiography between October 1, 2004 and May 31, 2007 at the Dallas Veterans Affairs Medical Center. Mean age was 65 +/- 9 years, 97% were men, and the mean time from CABG to diagnostic angiography was 8.2 +/- 6.1 years. Hypertension, low-density lipoprotein cholesterol, diabetes mellitus, smoking, and obesity were suboptimally controlled in 70%, 59%, 47%, 33%, and 50%, respectively. Intake of statins and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was 88% and 81%, respectively. After a mean follow-up of 1.4 +/- 0.8 years, the incidence of death and major cardiovascular events was 10% and 32%, respectively. In spite of significant improvement compared to previous studies and good compliance with indicated medications, contemporary prior CABG patients undergoing coronary angiography still have multiple and poorly controlled coronary artery disease risk factors and high risk for cardiovascular events. Novel pharmacologic and behavioral treatment strategies are needed.

Topics: Aged; Cardiovascular Agents; Cardiovascular Diseases; Coronary Angiography; Coronary Artery Bypass; Coronary Artery Disease; Diabetes Mellitus; Dyslipidemias; Humans; Hypertension; Hypoglycemic Agents; Incidence; Kaplan-Meier Estimate; Male; Middle Aged; Obesity; Prevalence; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Risk Factors; Smoking; Texas; Time Factors; Treatment Outcome; Veterans

Overweight and obesity are frequently associated with preventable death and have emerged as a major challenge to public health. There is an ongoing debate on the role of abdominal obesity and its value in predicting cardiovascular and renal outcomes. The present analysis evaluates the prevalence of microalbuminuria (MAU) and conventional cardiovascular risk factors in relation to measures of general and abdominal obesity.. In this multinational, observational study, 20828 hypertensive out-patients from 26 countries including Europe, North and Latin America, Middle East, and Asia were analyzed. Urinary dipstick screening for MAU was performed as well as data on patient demographics, anthropometric measures, cardiovascular risk factors, comorbid conditions, and cardiovascular drug therapy collected. MAU prevalence was determined by a stepwise logistic regression analysis with cardiovascular risk factors as univariate.. In the univariate analysis, MAU prevalence systematically increased with body mass index (BMI) from 54.4% (1st tertial) to 62.1% (3rd tertial) (p < 0.0001), an increase which was also observed for waist circumference (WC). At any level of BMI, MAU increased with WC from 53.5%, 54.8%, and 55.0% (1st tertial of WC in all three BMI tertials) to 61.4%, 62.1%, and 64.0% (3rd tertial of WC in all BMI tertials) (p < 0.0001). In the multivariate analysis, WC, but not BMI was independently associated with MAU. Furthermore, overweight/obesity were associated with the presence of modifiable and nonmodifiable risk factors.. An abnormal WC, but not BMI appears to be independently associated with MAU, an early marker of cardiovascular and renal risk. Increasing WC confers an incremental risk for MAU at any level of BMI, underlining the prognostic importance of abdominal fat accumulation beyond general obesity.

Topics: Albuminuria; Asia; Body Mass Index; Cardiovascular Agents; Cardiovascular Diseases; Cross-Sectional Studies; Europe; Female; Humans; Hypertension; Latin America; Logistic Models; Male; Middle Aged; Obesity; Odds Ratio; Prevalence; Risk Assessment; Risk Factors; Waist Circumference

Topics: Attitude of Health Personnel; Cardiovascular Agents; Cardiovascular Diseases; Diabetes Complications; Diet; Dyslipidemias; Exercise; Guideline Adherence; Health Knowledge, Attitudes, Practice; Health Policy; Health Promotion; Humans; Hypertension; Life Style; Metabolic Syndrome; Practice Guidelines as Topic; Preventive Health Services; Risk Assessment; Risk Factors; Risk Reduction Behavior; Smoking; Smoking Cessation

To compare the risk of mortality of nonagenarian siblings with that of sporadic nonagenarians (not selected on having a nonagenarian sibling) and to compare the prevalence of morbidity in their offspring with that of the offsprings' partners.. Longitudinal (mortality risk) and cross-sectional (disease prevalence).. Nationwide sample.. The Leiden Longevity Study consists of 991 nonagenarian siblings derived from 420 Caucasian families, 1,365 of their offspring, and 621 of the offsprings' partners. In the Leiden 85-plus Study, 599 subjects aged 85 were included, of whom 275 attained the age of 90 (sporadic nonagenarians).. All nonagenarian siblings and sporadic nonagenarians were followed for mortality (with a mean+/-standard deviation follow-up time of 2.7+/-1.4 years and 3.0+/-1.5 years, respectively). Information on medical history and medication use was collected for offspring and their partners.. Nonagenarian siblings had a 41% lower risk of mortality (P<.001) than sporadic nonagenarians. The offspring of nonagenarian siblings had a lower prevalence of myocardial infarction (2.4% vs 4.1%, P=.03), hypertension (23.0% vs 27.5%, P=.01), diabetes mellitus (4.4% vs 7.6%, P=.004), and use of cardiovascular medication (23.0% vs 28.9%, P=.003) than their partners.. The lower mortality rate of nonagenarian siblings and lower prevalence of morbidity in their middle-aged offspring reinforce the notion that resilience against disease and death have similar underlying biology that is determined by genetic or familial factors.

Topics: Aged, 80 and over; Cardiovascular Agents; Cause of Death; Cross-Sectional Studies; Diabetes Mellitus; Female; Follow-Up Studies; Health Surveys; Humans; Hypertension; Longevity; Longitudinal Studies; Male; Morbidity; Mortality; Myocardial Infarction; Netherlands; Phenotype; Proportional Hazards Models; Prospective Studies; Risk; Siblings

Topics: Animals; Cardiovascular Agents; Disease Models, Animal; Dogs; Glucagon-Like Peptide 1; Glucose Transporter Type 4; Heart Failure; Hypertension; Infusions, Parenteral; Insulin; Myocardium; Phosphorylation; Proto-Oncogene Proteins c-akt; Rats; Rats, Inbred SHR; Signal Transduction; Systole; Ventricular Function, Left

A 69 year old man was admitted with unstable angina (Class IIB). He had a history of chronic renal impairment, diabetes mellitus, hypertension and coronary bypass surgery in 1997 (LIMA graft to the LAD anf diagonal branch, saphenous vein grafts to the RCA and first marginal branch of LCx.. Coronary angiography.. Unstable angina (Class IIB). Occlusion of the LCx and RCA. Functionally occluded LIMA on the LAD and diagonal branch. Diffuse disease of the LAD with two significant lesions at the LAD-first diagonal and mid-distal LAD.. Revascularisation.

Topics: Aged; Angina, Unstable; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Chronic Disease; Coronary Angiography; Coronary Artery Bypass; Coronary Artery Disease; Diabetes Complications; Drug-Eluting Stents; Everolimus; Graft Occlusion, Vascular; Hemodynamics; Humans; Hypertension; Kidney Diseases; Male; Sirolimus; Treatment Outcome

Retrospective analysis of the prescribing practice and cost of ambulatory treatment of hypertension and its common complications--heart failure, sequelae of cerebrovascular disease, and angina pectoris.. Analysis of 3,240 reimbursable ambulatory prescriptions for hypertension, heart failure, sequelae of cerebrovascular disease and angina pectoris according to the complexity of the therapy and frequency of the prescribed medicines. Modeling and calculation of the expected monthly cost for outpatient therapy by using the "decision tree model". Sensitivity analysis is performed within the +/- 30% interval.. 65% of the prescription were for the hypertension, and 35% for the observed complications. 1,297 prescriptions for hypertension include one medicine, 647 include two medicines, and only 8% of prescriptions were for three medicines. ACE inhibitors have been prescribed in 41% of all hypertension prescriptions, followed by beta-blockers (19%), Ca channel blockers (16%), diuretics (15%) etc. The prescriptions for hypertension complications are more diverse as therapeutic groups. The expected monthly cost of prescribed medicines per patient with hypertension alone is 6.90 Euro and in case of complications it is 10.71 Euro according to the prevalence of the complexity of therapy, and weighted monthly cost of medicines. The overall ambulatory cost is expected to be around 148 million Euro per year for near 1.5 million patients with 44% reimbursement. The cost of the therapy is sensitive more to changes in the medicine's prices than to its complexity.. This study is a first step in providing information for evidence-based cost containment measures or policy decisions at ambulatory level in Bulgaria and for the assessment of the share of complications' therapy on the overall hypertension cost.

Topics: Ambulatory Care; Angina Pectoris; Antihypertensive Agents; Cardiovascular Agents; Cardiovascular Diseases; Decision Trees; Drug Therapy, Combination; Drug Utilization; Heart Failure; Humans; Hypertension; Practice Patterns, Physicians'; Prescription Fees; Retrospective Studies

Tako-tsubo cardiomyopathy has been gradually recognized worldwide. However, medications for the prevention remain not to be investigated in part because the precise mechanism is unclear. We sought to examine medications before the onset of tako-tsubo cardiomyopathy, and to prove the limitation of these medications for the prevention.. This study consisted of 21 patients with tako-tsubo cardiomyopathy who received one or more medications for hypertension or suspected angina pectoris. Each patient was assessed with history, medications, coronary angiography and left ventriculography. All patients but 1 were female, and age ranged 41 to 87 years (73+/-11 years). Twelve patients received calcium channel blockers, 7 patients received nitrates, and one patient received beta blocker. Three patients received angiotensin coverting enzyme inhibitors, and 4 patients received angiotensin II receptor blockers. One patient died of serious pneumonia, but there was no patient who died of tako-tsubo cardiomyopathy itself. During the 3 year follow-up, one patient receiving angiotensin receptor blocker had the recurrence of tako-tsubo cardiomyopathy due to recurrent epileptic seizure.. Tako-tsubo cardiomyopathy can occur despite treatment with calcium channel blockers, nitrates or beta-blockers, suggesting limitation of these medications to prevent tako-tsubo cardiomyopathy.

Topics: Adult; Aged; Aged, 80 and over; Angina Pectoris; Cardiovascular Agents; Female; Follow-Up Studies; Humans; Hypertension; Male; Middle Aged; Pharmaceutical Preparations; Takotsubo Cardiomyopathy

Topics: Cardiovascular Agents; Cardiovascular Diseases; Clinical Trials as Topic; Coronary Artery Disease; Humans; Hypertension

Topics: Cardiovascular Agents; Cardiovascular Diseases; Humans; Hypertension

Heartwatch, a secondary prevention programme in primary care was initiated in 2003, based on the second European Joint Task Force recommendations for secondary prevention of coronary heart disease (CHD). The aim was to examine the effect of the first 2 years of the Heartwatch programme on cardiovascular risk factors and treatments.. Prospective cohort study of patients with established CHD enrolled into the Heartwatch programme.. Four hundred and seventy (20%) general practitioners nationwide participated in the programme, recruiting 11,542 patients with established CHD (earlier myocardial infarction, coronary intervention or coronary artery bypass surgery). Clinical data were electronically transferred by each general practitioner to a central database. Comparison of changes in risk factors and treatments at 1-year and 2-year follow-up from baseline were made using paired t-test for continuous and McNemar's test for categorical data.. Statistically significant changes in systolic blood pressure, diastolic blood pressure, total and low-density lipoprotien cholesterol and smoking status at 1 and 2 years (P <0.0001) were observed. Little or no improvements were shown for exercise, BMI or waist circumference. Increases in the prescribing of statins, angiotensin-converting enzyme inhibitors and beta-blockers over the course of the study were observed.. The Heartwatch programme has demonstrated significant improvements in the main risk factors and treatments for CHD. More effective interventions are required to reduce BMI, waist circumference and physical inactivity in this population. The increases in treatment uptake are approaching the optimal levels in this population.

Topics: Adrenergic beta-Antagonists; Aged; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Cardiovascular Agents; Coronary Disease; Databases as Topic; Diabetes Complications; Dyslipidemias; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypertension; Hypoglycemic Agents; Ireland; Male; Medical Records Systems, Computerized; Middle Aged; Obesity; Primary Health Care; Program Evaluation; Prospective Studies; Risk Factors; Secondary Prevention; Smoking; Smoking Cessation; Smoking Prevention; Time Factors; Treatment Outcome

This study aimed to investigate the association between inadequately controlled hypertension, medication use pattern and the incidence of cardiovascular events (CVEs) over 5 years. The cost of hospitalisation associated with inadequately controlled hypertension was estimated.. This was a retrospective observational study of patients who were diagnosed with hypertension with at least one blood pressure reading recorded at baseline (year 2000), reviewed from 2001-2005. Primary endpoints were the extent, duration and prevalence of blood pressure deviation from treatment goals. Secondary endpoints were incidence of CVEs and the number of days of hospitalisation associated with inadequately controlled hypertension.. In total, the medical records of 210 patients were reviewed. Statistically significant positive associations were found between inadequately controlled systolic blood pressure with the incidence of CVEs (p=0.018) and increased cardiovascular drugs (p<0.001), non-cardiovascular drugs (p=0.019) and total drug usage (p<0.001). Similar observations were observed between inadequately controlled diastolic blood pressure and increased cardiovascular (p<0.05) and total (p=0.007) drug usage. Patients with uncontrolled blood pressure at all times during the study period were associated with a higher incidence of CVEs (p=0.026). The mean cost of hospitalisation due to CVEs was estimated to be HK$42,584.0 +/- 36,670.0 (US$1 = HK$7.8) and it accounted for 3.3% of the total healthcare expenditure during 2005.. Inadequately controlled blood pressure is positively associated with an increased incidence of CVEs and polypharmacy in Hong Kong Chinese hypertensive patients.

Topics: Age Factors; Aged; Cardiovascular Agents; Comorbidity; Drug Utilization; Female; Hong Kong; Hospitalization; Humans; Hypertension; Incidence; Male; Middle Aged; Retrospective Studies; Sex Factors; Treatment Outcome

Variations in the resources, stability and priorities of health care systems conceivably affect their capacity to implement health care reform and ensure an evidence based approach to health care. Such variation may partially account for differences in cardiovascular mortality rates between former communist states in Central Europe and Western European countries, but specific data on this subject is sparse. The aim of this study was to compare the presentation of stable angina to cardiology services in Poland vs. the United Kingdom, the management of the condition in relation to existing European guidelines and clinical outcome.. Data was collected as part of a prospective observational cohort study of stable angina in Europe. Information was recorded on referral patterns, clinical presentation and the use of pharmacological therapies, investigations, revascularisation and cardiovascular events during 1 year of follow up. A total of 571 patients with stable angina were enrolled in Poland and 319 in the UK. Patients presenting to cardiology services in Poland were less likely to be referred by a primary care physician, younger, and had more adverse clinical risk predictors at presentation. Non-invasive investigation and coronary angiography were performed less frequently in Poland, but waiting times for invasive assessment were shorter. European guidelines with regard to the use of evidence based secondary preventative medical therapy were applied widely by cardiologists in both countries. No differences were observed in rates of cardiovascular events.. The use of evidence based pharmacological therapy was equally high in both countries, but guidelines regarding investigation were less completely adhered to in Poland, where invasive assessment and subsequent management was prompt but only performed in a highly selected proportion of the population with stable angina.

Topics: Age Distribution; Aged; Angina Pectoris; Cardiovascular Agents; Coronary Angiography; Coronary Circulation; Drug Utilization; Electrocardiography; Exercise Test; Female; Follow-Up Studies; Guideline Adherence; Heart Failure; Humans; Hyperlipidemias; Hypertension; Male; Middle Aged; Myocardial Revascularization; Peripheral Vascular Diseases; Poland; Practice Guidelines as Topic; Primary Health Care; Prospective Studies; Referral and Consultation; Sex Distribution; United Kingdom

Much effort has been made to study first-ever stroke patients. However, recurrent stroke has not been investigated as extensively. It is unclear which risk factors dominate, and whether adequate secondary prevention has been provided to patients who suffer from recurrent stroke. Also, the different types of recurrent stroke need further evaluation.. The study included patients with recurrent stroke admitted to twenty-three Swedish stroke centers. The type of previous and recurrent stroke was determined, as well as evaluation (when applicable) of recurrent ischemic stroke according to the TOAST classification. Presence of vascular risk factors was registered and compared to the type of stroke. Also assessed was ongoing secondary prevention treatment at recurrent stroke onset.. A total of 889 patients with recurrent stroke (mean age 77) were included in the study. Of these, 805 (91%) had ischemic stroke, 78 (9%) had intracerebral hemorrhage and 6 (<1%) stroke of unknown origin. The most frequent vascular risk factors were hypertension (75%) and hyperlipidemia (56%). Among the 889 patients, 29% had atrial fibrillation. Of the patients in the ischemic group with cardiac embolism, only 21% were on anticoagulation treatment. The majority of the patients (75%) had their most recent previous stroke >12 months before admission.. Few patients had a recurrent stroke shortly after the previous stroke in this study. This indicates that it is meaningful to prevent a second event with an adequate long-term treatment strategy for secondary prevention after first-ever stroke. There also seems to be a clear potential for improving secondary prevention after stroke.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Antihypertensive Agents; Atrial Fibrillation; Brain Ischemia; Cardiovascular Agents; Cerebral Hemorrhage; Diabetes Complications; Embolism; Female; Humans; Hyperlipidemias; Hypertension; Male; Middle Aged; Odds Ratio; Platelet Aggregation Inhibitors; Registries; Risk Assessment; Risk Factors; Secondary Prevention; Smoking; Stroke; Sweden; Time Factors; Treatment Outcome

Topics: Cardiovascular Agents; Death, Sudden, Cardiac; Diabetes Mellitus, Type 2; Humans; Hyperkalemia; Hypertension; Hypertrophy, Left Ventricular; Hypoglycemic Agents; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis; Risk Factors; Sulfonylurea Compounds

The first results of a big Russian multicenter study " RELIF - Regular treatment and prevention - the key of improvement of the situation with cardiovascular diseases in Russia " are presented. The study examines the accordance of arterial hypertension (AH) and coronary heart disease (CHD) treatment recommended by physicians to contemporary standards. Patients adherence to physicians recommendations is also studied. 512 general practitioners and 2517 patients with AH and CHD from 20 cities of Russia were included. In the present article the current situation with medical treatment of AH, isolated or in comorbidity with CHD is presented.

Topics: Cardiovascular Agents; Coronary Disease; Follow-Up Studies; Humans; Hypertension; Morbidity; Patient Compliance; Prognosis; Retrospective Studies; Russia

During the past 18 years, sildenafil has evolved from a potential anti-angina drug to an on-demand treatment for erectile dysfunction and more recently to a new orally active treatment for pulmonary hypertension. Recent studies suggest that the drug has powerful cardioprotective effect against ischemia/reperfusion injury, doxorubicin-induced cardiomyopathy and anti-hypertensive effect induced by chronic inhibition of nitric oxide synthase in animals. Based on several recent basic and clinical studies, it is clear that sildenafil and other clinically approved type-5 phosphodiesterase-5 inhibitors including vardenafil and tadalafil will eventually be developed for several cardiovascular indications including essential hypertension, endothelial dysfunction, ischemia/reperfusion injury, myocardial infarction, ventricular remodeling and heart failure.

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Animals; Antihypertensive Agents; Carbolines; Cardiomyopathies; Cardiovascular Agents; Cyclic Nucleotide Phosphodiesterases, Type 5; Disease Models, Animal; Doxorubicin; Endothelium, Vascular; Enzyme Inhibitors; Erectile Dysfunction; Heart Failure; Humans; Hypertension; Hypertension, Pulmonary; Imidazoles; Male; Myocardial Infarction; Myocardial Reperfusion Injury; NG-Nitroarginine Methyl Ester; Nitric Oxide; Phosphodiesterase Inhibitors; Piperazines; Purines; Sildenafil Citrate; Sulfones; Tadalafil; Triazines; Vardenafil Dihydrochloride; Vasodilator Agents; Ventricular Remodeling

Phosphodiesterase-5 inhibitors are beneficial in pulmonary hypertension and congestive heart failure, the two conditions associated with coronary heart disease and ischaemia. We investigated whether sildenafil counteracts the cardiovascular alterations induced by N -nitro-L-arginine methyl ester (L-NAME) in the rat.. Sildenafil was given orally to rats at doses of 0.37, 0.75 or 1.5 mg kg-1day-1 for four weeks, either alone or with L-NAME (35-40 mg kg-1 day-1 in the drinking water). Systolic blood pressure and urinary parameters (6-keto-prostaglandin F1alpha, thromboxane B2, 8-isoprostane-prostaglandin F2 and nitrite/nitrate) were measured in conscious rats. Isolated hearts were subjected to low flow ischaemia-reperfusion, and myocardial levels of guanosine 3', 5'cyclic monophosphate (cGMP) were determined. Endothelial vascular dysfunction was examined in aortic rings.. Sildenafil dose-dependently prevented the rise in systolic blood pressure in L-NAME-treated rats. This activity was associated with a normalization of urinary 8-isoprostane-prostaglandin F2alpha and other biochemical parameters. In perfused hearts, the post-ischaemic ventricular dysfunction was worse in preparations from L-NAME-treated rats than in controls. Sildenafil dose-dependently reduced this effect, and creatine kinase and lactate dehydrogenase release were lower too. cGMP levels, which were low in myocardial tissue from L-NAME-treated rats, were restored by sildenafil. In noradrenaline-precontracted aortic rings from L-NAME-treated rats acetylcholine lost its vasorelaxant effect, and sildenafil restored it.. In a rat model of chronic nitric oxide deprivation, where hypertension and aggravation of post-ischaemic ventricular dysfunction are associated with loss of vascular endothelium-relaxant function, sildenafil provided significant cardiovascular protection, primarily by maintaining tissue cGMP levels.

Topics: Animals; Antihypertensive Agents; Biomarkers; Blood Pressure; Cardiovascular Agents; Cyclic GMP; Disease Models, Animal; Dose-Response Relationship, Drug; Endothelium, Vascular; Enzyme Inhibitors; Heart Rate; Hypertension; Male; Myocardial Reperfusion Injury; NG-Nitroarginine Methyl Ester; Nitric Oxide Synthase; Phosphodiesterase Inhibitors; Piperazines; Purines; Rats; Rats, Wistar; Severity of Illness Index; Sildenafil Citrate; Sulfones; Time Factors; Vasodilation; Vasodilator Agents; Ventricular Function

The worse prognosis in patients without ST-elevation (non-STEMI) as compared to ST-elevation myocardial infarction (STEMI), may be due to treatment differences. We aimed to evaluate the differences in characteristics, treatment and outcome in patients with non-STEMI versus STEMI in an unselected patient population.. Individual patient data from all patients in our hospital with a discharge diagnosis of MI between Jan 2001 and Jan 2002 were evaluated. Follow-up data were obtained until December 2004. Patients were categorized according to the presenting electrocardiogram into non-STEMI or STEMI.. A total of 824 patients were discharged with a diagnosis of MI, 29% with non-STEMI and 71% with STEMI. Patients with non-STEMI were significantly older and had a higher cardiovascular risk profile. They underwent less frequently coronary angiography and revascularization and received less often clopidogrel and ACE-inhibitor on discharge. Long-term mortality was significantly higher in the non-STEMI patients as compared to STEMI patients, 20% vs. 12%, p = 0.006, respectively. However, multivariate analysis showed that age, diabetes, hypertension and no reperfusion therapy (but not non-STEMI presentation) were independent and significant predictors of long-term mortality.. In an unselected cohort of patients discharged with MI, there were significant differences in baseline characteristics, and (invasive) treatment between STEMI and non-STEMI. Long-term mortality was also different, but this was due to differences in baseline characteristics and treatment. More aggressive treatment may improve outcome in non-STEMI patients.

Topics: Age Distribution; Aged; Angioplasty, Balloon, Coronary; Cardiac Catheterization; Cardiology; Cardiovascular Agents; Cohort Studies; Comorbidity; Coronary Artery Bypass; Diabetes Mellitus; Female; Follow-Up Studies; Humans; Hypertension; Male; Middle Aged; Myocardial Infarction; Myocardial Reperfusion; Netherlands; Outcome and Process Assessment, Health Care; Prognosis; Proportional Hazards Models; Quality of Health Care; Risk Factors; Survival Analysis

The aim of this population-based cohort study was to examine the changes in the regular use of cardiovascular medication among the elderly aged 75 years or more in Finland in 1998 and 2003.. The study population (n = 700) was a random sample of all persons aged 75 years or more living in Kuopio, in eastern Finland. Of them, 601 persons participated in 1998. The surviving persons (n = 339) were re-examined in 2003. Of them 85% (n = 289) were home-dwelling and 15% (n = 50) lived in institutional care. Data on their use of medication and their physical and mental health was collected from interviews conducted by trained nurses.. From 1998 to 2003 regular use of one or more cardiovascular medicine increased from 80% to 87% among all the survivors (n = 339, P < 0.001). The mean number of regularly used cardiovascular medicines increased from 2.1 (95% CI 1.9-2.3) to 2.7 (95% CI 2.5-2.9, P < 0.001) during the follow-up period. The most commonly used cardiovascular medicines were beta-blocking agents. The proportion of users of beta-blocking agents was in 1998 45% and in 2003 51%. The proportion of users of diuretics increased from 27% to 40% (P < 0.001), users of cardiac therapy from 35% to 43% (P < 0.001), users of ACE inhibitors and AT 1 receptor antagonists from 20% to 30% (P < 0.001) and users of lipid modifying agents from 7% to 12%.. The use of cardiovascular medicines was common among elderly persons. The proportion of users increased with age and over time. A large proportion of elderly persons would need medication monitoring focusing on cardiovascular medication.

Topics: Adrenergic beta-Antagonists; Age Factors; Aged; Aged, 80 and over; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Aspirin; Cardiovascular Agents; Cohort Studies; Digoxin; Diuretics; Drug Utilization; Finland; Homebound Persons; Humans; Hypertension; Institutionalization; Nitrates; Survivors; Time Factors; Warfarin

Topics: Blood Pressure; Cardiovascular Agents; Deja Vu; Humans; Hypertension; Practice Guidelines as Topic; Risk Factors; Treatment Outcome

Topics: Blood Pressure; Cardiovascular Agents; Cardiovascular Diseases; Diabetes Mellitus; Dyslipidemias; Europe; Female; Genetic Predisposition to Disease; Guideline Adherence; Health Promotion; Heart Rate; Humans; Hypertension; Hypoglycemic Agents; Hypolipidemic Agents; Inflammation; Kidney Diseases; Life Style; Lipids; Male; Metabolic Syndrome; Motor Activity; Nutritional Physiological Phenomena; Obesity; Overweight; Primary Prevention; Risk Assessment; Risk Factors; Sex Factors; Smoking; Smoking Cessation; Stress, Psychological; Treatment Outcome

Topics: Blood Pressure; Cardiovascular Agents; Cardiovascular Diseases; Diabetes Mellitus; Dyslipidemias; Female; Genetic Predisposition to Disease; Guideline Adherence; Health Promotion; Heart Rate; Humans; Hypertension; Hypoglycemic Agents; Hypolipidemic Agents; Inflammation; Kidney Diseases; Life Style; Lipids; Male; Metabolic Syndrome; Motor Activity; Nutritional Physiological Phenomena; Obesity; Overweight; Primary Prevention; Risk Assessment; Risk Factors; Sex Factors; Smoking; Smoking Cessation; Stress, Psychological; Treatment Outcome

Topics: Aged, 80 and over; Arrhythmias, Cardiac; Cardiovascular Agents; Colitis, Ischemic; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Digoxin; Drug Therapy, Combination; Female; Humans; Hypertension; Intestinal Mucosa; Nicardipine; Postoperative Complications; Propranolol; Risk Factors; Sigmoid Neoplasms

Topics: Anticoagulants; Calcium Channel Blockers; Cardiovascular Agents; Cardiovascular Diseases; Diabetes Complications; Fibrinolytic Agents; Humans; Hypercholesterolemia; Hypertension; Metabolic Syndrome; Platelet Aggregation Inhibitors; Risk Factors; Stents

Topics: Adrenergic beta-Antagonists; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Atherosclerosis; Cardiovascular Agents; Coronary Artery Disease; Diabetes Mellitus; Dyslipidemias; Health Behavior; Hematologic Agents; Humans; Hypertension; Hypolipidemic Agents; Influenza Vaccines; Mineralocorticoid Receptor Antagonists; Motor Activity; Obesity; Smoking Cessation

Topics: Arteries; Cardiovascular Agents; Cardiovascular Diseases; Glycation End Products, Advanced; Guanidines; Hypertension

Earlier studies evaluating long-term survival in type A acute aortic dissection (TA-AAD) have been restricted to a small number of patients in single center experiences. We used data from a contemporary, multi-center international registry of TA-AAD patients to better understand factors associated with long-term survival.. We examined 303 consecutive patients with TA-AAD enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2003. We included patients who were discharged alive and had documented clinical follow-up data. Kaplan-Meier survival curves were constructed to depict cumulative survival in patients from date of hospital discharge. Stepwise Cox proportional hazards analysis was performed to identify independent predictors of follow-up mortality. We found that 273 (90.1%) patients had been managed surgically and 30 (9.9%) were managed medically. Patients who were dead at follow-up were more likely to be older (63.9 versus 58.4 years, P=0.007) and to have had previous cardiac surgery (23.9% versus 10.6%, P=0.01). Survival for patients treated with surgery was 96.1%+/-2.4% and 90.5%+/-3.9% at 1 and 3 years versus 88.6%+/-12.2% and 68.7%+/-19.8% without surgery (mean follow-up overall, 2.8 years, log rank P=0.009). Multivariate analysis identified a history of atherosclerosis (relative risk (RR), 2.17; 95% confidence interval [CI], 1.08 to 4.37; P=0.03) and previous cardiac surgery (RR, 2.54; 95% CI, 1.16 to 5.57; P=0.02) as significant, independent predictors of follow-up mortality.. Contemporary 1- and 3-year survival in patients with TA-AAD treated surgically are excellent. Independent predictors of survival during the follow-up period do not appear to be influenced by in-hospital risks but rather preexisting comorbidities.

Topics: Acute Disease; Age Factors; Aged; Antihypertensive Agents; Aortic Aneurysm; Aortic Dissection; Atherosclerosis; Cardiac Surgical Procedures; Cardiovascular Agents; Case Management; Comorbidity; Europe; Female; Follow-Up Studies; Humans; Hypertension; Japan; Life Tables; Male; Middle Aged; Mortality; Patient Discharge; Postoperative Complications; Proportional Hazards Models; Registries; Risk Factors; Survival Analysis; Treatment Outcome; United States

The clinical profiles and outcomes of patients treated surgically for acute type B aortic dissection (ABAD) are often reported for those in small series or for those cared for at a single institution over a long time period, during which a continuous evolution in techniques has occurred. Accordingly, we sought to evaluate the clinical features and surgical results of patients enrolled in the International Registry of Acute Aortic Dissection by identifying primary factors that influenced surgical outcome and estimating average surgical mortality for ABAD in the current era.. A comprehensive analysis of 290 clinical variables and their relation to surgical outcomes for 82 patients who required surgery for ABAD (from a population of 1256 patients; mean+/-SD age, 60.6+/-15.0 years; 82.9% male) and who were enrolled in the International Registry of Acute Aortic Dissection was performed. The overall in-hospital mortality was 29.3%. Factors associated with increased surgical mortality based on univariate analysis were preoperative coma or altered consciousness, partial thrombosis of the false lumen, evidence of periaortic hematoma on diagnostic imaging, descending aortic diameter >6 cm, right ventricle dysfunction at surgery, and shorter time from the onset of symptoms to surgery. Factors associated with favorable outcomes included radiating pain, normotension at surgery (systolic blood pressure 100 to 149 mm Hg), and reduced hypothermic circulatory arrest time. The 2 independent predictors of surgical mortality were age >70 years (odds ratio, 4.32; 95% confidence interval, 1.30 to 14.34) and preoperative shock/hypotension (odds ratio, 6.05; 95% confidence interval, 1.12 to 32.49).. The present study provides insights into current-day clinical profiles and surgical outcomes of ABAD. Knowledge about different preoperative clinical conditions may help surgeons in making treatment decisions among these high-risk patients.

Topics: Acute Disease; Aged; Anastomosis, Surgical; Antihypertensive Agents; Aortic Aneurysm, Thoracic; Aortic Dissection; Aortic Rupture; Atherosclerosis; Blood Vessel Prosthesis Implantation; Cardiovascular Agents; Comorbidity; Disease Susceptibility; Europe; Female; Follow-Up Studies; Heart Diseases; Hemodynamics; Hospital Mortality; Humans; Hypertension; Japan; Male; Marfan Syndrome; Middle Aged; Paraplegia; Postoperative Complications; Registries; Spinal Cord Ischemia; Stents; Survival Analysis; Treatment Outcome; United States

Anti-hypertensive agents may differently stimulate compensatory neuro-hormonal mechanisms and induce different effects on the cardiovascular remodeling and function. The combination of low doses of the two synergistic drugs may lead to a lesser activation of counter regulatory mechanisms and could provide optimal therapeutic benefit. We evaluated on spontaneously hypertensive rats the effect of 3-week period of anti-hypertensive treatment. Rats were divided into four groups: control, bisoprolol (100 mg kg-1), hydrochlorothiazide (10 mg kg-1), and their combination with low doses (10 and 1 mg kg-1, respectively). The effects of treatment were evaluated on neuro-hormonal stimulation, cardiac and vascular structure and function. The combination had synergistic anti-hypertensive effects and significantly reduced heart rate and blood pressure but to a lower extent compared with bisoprolol 100 mg kg-1. Combination therapy was associated with a lower renin activation compared to hydrochlorothiazide alone and improved endothelial function. Cardiovascular remodeling differed between the groups: with bisoprolol, cardiac hypertrophy was reduced; with the combination therapy, the aortic media/lumen ratio was most increased. The consequent shear stress reduction may explain the associated endothelial function improvement. Such favourable cardiovascular remodeling with diuretic-beta-blockade combination may participate to the long-term cardiovascular protection during anti-hypertensive treatment.

Topics: Animals; Bisoprolol; Cardiovascular Agents; Dose-Response Relationship, Drug; Drug Synergism; Drug Therapy, Combination; Heart Rate; Hydrochlorothiazide; Hypertension; Male; Rats; Rats, Inbred SHR; Ventricular Remodeling

Few data have evaluated physician adherence to cardiovascular disease (CVD) prevention guidelines according to physician specialty or patient characteristics, particularly gender.. An online study of 500 randomly selected physicians (300 primary care physicians, 100 obstetricians/gynecologists, and 100 cardiologists) used a standardized questionnaire to assess awareness of, adoption of, and barriers to national CVD prevention guidelines by specialty. An experimental case study design tested physician accuracy and determinants of CVD risk level assignment and application of guidelines among high-, intermediate-, or low-risk patients. Intermediate-risk women, as assessed by the Framingham risk score, were significantly more likely to be assigned to a lower-risk category by primary care physicians than men with identical risk profiles (P<0.0001), and trends were similar for obstetricians/gynecologists and cardiologists. Assignment of risk level significantly predicted recommendations for lifestyle and preventive pharmacotherapy. After adjustment for risk assignment, the impact of patient gender on preventive care was not significant except for less aspirin (P<0.01) and more weight management recommended (P<0.04) for intermediate-risk women. Physicians did not rate themselves as very effective in their ability to help patients prevent CVD. Fewer than 1 in 5 physicians knew that more women than men die each year from CVD.. Perception of risk was the primary factor associated with CVD preventive recommendations. Gender disparities in recommendations for preventive therapy were explained largely by the lower perceived risk despite similar calculated risk for women versus men. Educational interventions for physicians are needed to improve the quality of CVD preventive care and lower morbidity and mortality from CVD for men and women.

Topics: Attitude of Health Personnel; Cardiology; Cardiovascular Agents; Cardiovascular Diseases; Case Management; Cross-Sectional Studies; Data Collection; Diabetes Mellitus; Drug Utilization; Female; Guideline Adherence; Gynecology; Health Knowledge, Attitudes, Practice; Humans; Hyperlipidemias; Hypertension; Male; Obstetrics; Patient Education as Topic; Physicians; Practice Guidelines as Topic; Practice Patterns, Physicians'; Primary Health Care; Risk; Risk Assessment; Sampling Studies; Sex Factors; Weight Loss

Topics: Bias; Cardiovascular Agents; Crime; Databases, Nucleic Acid; Drug Combinations; Forensic Sciences; Gene Frequency; Genetic Variation; Genetics, Medical; Heart Diseases; Humans; Hydralazine; Hypertension; Isosorbide Dinitrate; Pharmacogenetics; Phenotype; Polymorphism, Single Nucleotide; Racial Groups

Most studies of cardiovascular risk factors (CVRF) conducted in our environment concentrate in a single CVRF. The PREVENCAT study was designed to estimate the control of CVRF in the population attended in primary care presenting arterial hypertension (HT), type 2 diabetes mellitus (DM2) and/or hypercholesterolemia (HC) as well as to assess the prevalence of Metabolic Syndrome in these patients.. Multicenter, cross-sectional study, in patients with HT, DM2 and/or HC, consecutively recruited by primary care physicians in Spain. The blood pressure, cholesterol, basal glycaemia, obesity, smoking and physical activity were assessed. The degree of control of these CVRF and the prevalence of MS were estimated.. 2,649 patients were recruited, aged 64 (11.3) years, with a 51.6% of women. The most frequent diagnosis was HT (78.9%), followed by HC (58.4%) and DM2 (37.4%). In the whole sample, the percentages of patients who had a control or had initially normal values of blood pressure, cholesterol and basal glycemia were 40.0% (confidence interval [CI], 95% 38.2-41.9), 42.6% (95% CI, 40.5-44.7) and 62.7% (95% CI, 60.8-64.5), respectively. 15.6% of cases (95% CI, 14.3-17.0) had body mass index < or = 25 kg/m2; 87.5% were non-current smokers (95% CI, 86.2-88.8); and 46.2% practiced regular physical activity (95% CI, 44.3-48.1). 40% of patients had < or = 2 CVRF in good control. The prevalence of metabolic syndrome was 50.6% (95% CI, 48.7-52.5).. The control of the CVRF considered in primary care attended population is insufficient. Hardly one of each 2 patients with HT, DM2 and HC is under control. The overweight and sedentarism control is still poorer.

Topics: Adult; Aged; Aged, 80 and over; Cardiovascular Agents; Cardiovascular Diseases; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Female; Humans; Hypercholesterolemia; Hypertension; Male; Middle Aged; Prevalence; Primary Health Care; Risk Factors; Spain

Prescriptions in cardiology have progressed from the often empirical and approximate approach used in the past to more rational approach based on the results of large clinical trials. For high blood pressure, bi- or even tri-therapy is often necessary. For coronary heart disease, betablockers, aspirin, calcium inhibitors, statins and converting enzyme inhibitors constitute the mainstay drugs. For myocardial infarction, the crucial point is to restore muyocardial perfusion as quickly as possible by thrombolysis or angioplasty. Polytherapy is required for heart failure. Finally, for atrial fibrillation, after anticoagulation, sinus rhythm can be restored with anticoagulant cover can be obtained with electrical shock or antiarrhythmic drugs.

Topics: Atrial Fibrillation; Cardiovascular Agents; Cardiovascular Diseases; Heart Failure; Humans; Hypertension

Patients with extensive coronary artery disease (CAD) have better prognosis when treated with coronary artery bypass grafting surgery (CABG), especially when left ventricular dysfunction (LVD) is present. However, there are scanty data about the clinical course of patients not referred to CABG because of extensive and severe atherosclerotic involvement of distal coronary arteries (ENDCAD). The aim of this study was to evaluate patients with multivessel (MV) or left main CAD (LM) who had CABG precluded because of ENDCAD.. Between August 1999 and July 2001, 51 patients who had clinical indication but were not eligible for CABG because of ENDCAD were followed for at least 12 months or until death. There were 32 men and 19 women (age 61+/-9 years). Previous acute myocardial infarction (AMI) was present in 31 (60.8%), diabetes mellitus (DM) in 28 (54.9%), systemic arterial hypertension in 37 (72.5%), LVD (left ventricular ejection fraction <40%) in 26 (51%), 3 vessel CAD in 31 (60.8%), and LM in 4 (7.8%). During follow-up there were 20 cardiac (39.2%) deaths, 19 (37.2%) AMI, and 3 (5.8%) patients developed congestive heart failure. There were 2 (3.9%) noncardiac deaths. Patients with DM (60.7% versus 13%; P=0.001; odds ratio [OR], 10.30; 95% confidence interval [CI], 2.46 to 43.09), LVD (76.9% versus 0%; P<0.0001; OR, 4.33; 95% CI, 2.14 to 8.74), 3-vessel CAD (51.6% versus 20%; P=0.039; OR, 4.26; 95% CI, 1.16 to 15.69), and LM (100% versus 34%; P=0.019; OR, 1.25; 95% CI, 1.004 to 1.556) were more likely to die. There was no deaths in patients with 2-vessel CAD but they had more nonfatal AMI (43.8% versus 14.3%; OR, 4.667; 95% CI, 1.188 to 18.332).. Patients in whom CABG could not be performed because of ENDCAD had high mortality, especially in the presence of LVD. DM (particularly insulin-dependent), LM CAD, and 3-vessel CAD were independent markers of increased risk.

Topics: Aged; Brazil; Cardiovascular Agents; Cause of Death; Comorbidity; Contraindications; Coronary Artery Bypass; Coronary Artery Disease; Diabetes Complications; Diabetes Mellitus; Female; Follow-Up Studies; Heart Failure; Humans; Hypertension; Male; Middle Aged; Myocardial Infarction

Patients with kidney disease and acute myocardial infarction (AMI) receive standard therapy, including thrombolytic medication, less frequently than patients with normal kidney function. Our goal is to identify potential differences in thrombolytic medication delays and thrombolytic-associated bleeding events by severity of kidney disease.. This is a retrospective cohort analysis of Cooperative Cardiovascular Project data for all Medicare patients with AMI from 4,601 hospitals. Outcome measures included time to administration of thrombolytic medication censored at 6 hours and bleeding events.. Of 109,169 patients (mean age, 77.4 years; 50.6% women), 13.9% received thrombolysis therapy. Average time to thrombolytic therapy was longer in patients with worse kidney function. Adjusted hazard ratios for minutes to thrombolytic therapy were 0.83 (95% confidence interval [CI], 0.79 to 0.87) for patients with a serum creatinine level of 1.6 to 2.0 mg/dL (141 to 177 micromol/L) and 0.58 (95% CI, 0.53 to 0.63) for patients with a creatinine level greater than 2.0 mg/dL (>177 micromol/L) or on dialysis therapy compared with those with normal kidney function. Odds ratios for bleeding events in patients administered thrombolytics versus those who were not decreased with worse kidney function: adjusted odds ratios, 2.28 (95% CI, 2.16 to 2.42) in patients with normal kidney function and 1.84 (95% CI, 1.09 to 3.10) in dialysis patients.. Patients with worse kidney function experienced treatment delays, but were not at greater risk for thrombolysis-associated excess bleeding events. Physician concerns of thrombolytic-associated bleeding may not be sufficient reason to delay the administration of thrombolytic medication.

Topics: Aged; Aged, 80 and over; Cardiovascular Agents; Cohort Studies; Comorbidity; Creatinine; Databases, Factual; Diabetes Mellitus; Female; Fibrinolytic Agents; Heart Diseases; Hemorrhage; Humans; Hypertension; Kidney Diseases; Life Tables; Male; Medicare; Myocardial Infarction; Peptic Ulcer; Proportional Hazards Models; Retrospective Studies; Sampling Studies; Thrombolytic Therapy; Time Factors; United States

Topics: Antihypertensive Agents; Black People; Cardiovascular Agents; Drug Combinations; Drug Labeling; Epidemiologic Measurements; Heart Failure; Humans; Hydralazine; Hypertension; Nitrates; Pediatrics; Renal Agents; United States; United States Food and Drug Administration

Chronic renal insufficiency (CRI) has been identified as an important risk factor for cardiac events. Studies in the United States reported decreased survival and decreased use of surgical and medical interventions after myocardial infarction in patients with CRI.. We studied the impact of renal function on health outcomes in a Canadian cohort of consecutive patients admitted with acute coronary syndrome (ACS) between October 1997 and October 1999. The study design is an observational cohort of 5,549 adult patients who survived to discharge with a discharge diagnosis of ACS. Renal function is classified into 4 levels: (1) normal, glomerular filtration rate (GFR) greater than 80 mL/min/1.73 m2 (>1.33 mL/s); (2) mild CRI, GFR of 60 to 80 mL/min/1.73 m2 (1.00 to 1.33 mL/s); (3) moderate CRI, GFR of 30 to 59 mL/min/1.73 m2 (0.50 to 0.98 mL/s); and (4) severe CRI, GFR less than 30 mL/min/1.73 m2 (<0.50 mL/s). The primary outcome is death.. Advanced and moderate CRI independently predicted death (hazard ratio, 1.06; 95% confidence interval [CI], 1.01 to 1.12; and hazard ratio, 1.23; 95% CI, 1.18 to 1.29). Severe anemia (hemoglobin level < 9.0 g/dL [<90 g/L]) also was an independent risk factor for death (hazard ratio, 1.38; 95% CI, 1.18 to 1.61). Use of beta-blockers (hazard ratio, 0.91; 95% CI, 0.86 to 0.97), acetylsalicylic acid (hazard ratio, 0.90; 95% CI, 0.84 to 0.97), lipid-lowering therapy (hazard ratio, 0.84; 95% CI, 0.78 to 0.89), and medical thrombolysis (hazard ratio, 0.89; 95% CI, 0.81 to 0.97) were associated with reduced risk for death. Medical interventions with beta-blockers, acetylsalicylic acid, lipid-lowering therapy, and thrombolysis and surgical intervention were significantly less likely to be used in patients with CRI.. Despite universal access to health care, Canadian patients with CRI are more likely to die after a cardiac event and less likely to receive important interventions.

Topics: Adrenergic beta-Antagonists; Adult; Aged; Anemia; Angina, Unstable; Angiotensin-Converting Enzyme Inhibitors; Aspirin; Cardiovascular Agents; Cohort Studies; Comorbidity; Drug Utilization; Female; Fibrinolytic Agents; Glomerular Filtration Rate; Humans; Hyperlipidemias; Hypertension; Hypolipidemic Agents; Kidney Failure, Chronic; Life Tables; Male; Middle Aged; Mortality; Myocardial Infarction; Myocardial Revascularization; Nova Scotia; Proportional Hazards Models; Prospective Studies; Registries; Risk Factors; Smoking; Survival Analysis; Thrombolytic Therapy; Treatment Outcome

To investigate the effect of trans-resveratrol on hypertension-induced cardiac hypertrophy and its potential mechanisms involving endothelin (ET), angiotensin II (AngII) and nitric oxide (NO).. Animal models bearing cardiac hypertrophy were replicated in male SD rats following partially nephrectomy (PNX). 10 mg/kg bw or 50 mg/kg bw of resveratrol was administered to rats by gavage, respectively, for 4 weeks. PNX control and sham-operation control (SHAM) were simultaneously established. Systolic pressure of rats was measured through tail at baseline and it, as well as heart weight, was measured after 4-week treatment. Serum ET-1 and AngII concentrations were determined using radioimmunological assay and NO using nitric acid reductase method.. After 4-week treatment, animals in PNX control group had significantly higher systolic pressure and heart weight, higher ET-1 and AngII concentrations while lower NO concentrations, compared with those in SHAM group (P < 0.05). Rats treated with 50 mg/kg bw of resveratrol had significantly lower systolic pressure and heart weight, lower ET-1 concentrations while higher NO concentrations, compared with animals in PNX group (P < 0.05).. Trans-resveratrol could protect against the increase of systonic pressure and subsequent cardiac hypertrophy in vivo, which mechanisms might, at least partly, involve with its modulation on NO, AngII and ET.

Topics: Angiotensin II; Animals; Cardiomegaly; Cardiovascular Agents; Endothelin-1; Hypertension; Male; Myocardium; Nephrectomy; Nitric Oxide; Random Allocation; Rats; Rats, Sprague-Dawley; Resveratrol; Stilbenes

Topics: Alcohol Drinking; Atrial Fibrillation; Cardiovascular Agents; Cardiovascular Surgical Procedures; Carotid Stenosis; Clinical Trials as Topic; Combined Modality Therapy; Diabetes Complications; Diabetes Mellitus; Epidemiologic Studies; Evidence-Based Medicine; Hormone Replacement Therapy; Humans; Hypercholesterolemia; Hypertension; Life Style; Smoking; Stroke

Topics: Acute Disease; Brain Edema; Brain Ischemia; Cardiovascular Agents; Case Management; Combined Modality Therapy; Decompression, Surgical; Fever; Humans; Hyperglycemia; Hypertension; Hypoxia; Intracranial Hypertension; Pneumonia; Thrombolytic Therapy; Urinary Tract Infections; Water-Electrolyte Imbalance

Despite the epidemiological importance of coronary artery disease, cardiovascular events are rare from the individual viewpoint. There is considerable uncertainty when to start medical treatment. A given risk factor modification results in a relative risk reduction independent of the global risk. Therefore the global risk determines the absolute benefit of a preventive measure. The global risk can be estimated using different scoring systems. Using the global risk and the expected relative risk reduction, the Number Needed to Treat (NNT) to avoid one event or cardiac death can be calculated. The NNT is a measure for the usefulness of a preventive intervention. A NNT of < 200 appears acceptable for primary prevention. This can be achieved with pharmacological preventive strategies if the global risk of 10 years is > or = 20%. As age is one of the most important risk predictors the need for treatment at comparable risk factor constellations is age dependent. Risk stratification with estimation of the NNT is therefore important for the decision to treat or not to treat.

Topics: Adult; Aged; Cardiovascular Agents; Cholesterol, HDL; Cholesterol, LDL; Coronary Disease; Cross-Sectional Studies; Death, Sudden, Cardiac; Diabetes Complications; Diabetes Mellitus; Female; Germany; Humans; Hypercholesterolemia; Hypertension; Male; Mass Screening; Middle Aged; Risk Assessment; Triglycerides

Cardiovascular disease (CVD) is less prevalent in premenopausal women and women receiving estrogen replacement therapy (ERT) than in postmenopausal women or men. It proposed that the cardiovascular effects of estrogen are mediated, at least in part, through the ability of estrogen to increase nitric oxide (NO) synthesis. This study investigated the effect of estrogen on serum NO concentrations in normotensive and deoxycorticostrone acetate (DOCA) Salt hypertensive ovariectomized rats.. Forty-eight female rats were ovariectomized and randomly divided into six groups. Hypertension was induced by DOCA Salt method. DOCA was injected 30 mg/kg of body weight subcutaneously, twice a week with NaCl 1% instead of tap water for drinking throughout the treatment period. Estradiol valerate (Es) was injected i.m. once a week. The groups were as follows: (2) DOCA (4 weeks) and DOCA+Es (6 weeks), (22) DOCA (10 weeks), (222) normal saline (N/S) (4 weeks)+Es (6 weeks), (2V) N/S (10 weeks), (V) DOCA (4 weeks), and (V2) N/S (4 weeks). Serum NO concentrations were measured in groups 1, 3 and 4 before and after treatment. Other groups were used as control.. Results showed that in normotensive animals, serum NO concentrations were increased after estrogen treatment significantly (90.20 +/- 18.67 vs. 19.11 +/- 1.78 micromol/l) (p < 0.05). Also, estrogen increased serum NO concentrations in DOCA Salt hypertensive rats (73.54 +/- 22.55 vs. 36.94 +/- 10.73 micromol/l) (p = 0.06).. Estrogen can increase serum NO concentrations in normotensive and DOCA Salt hypertensive animals and it may be important in cardiovascular effects of estrogen.

Topics: Animals; Blood Pressure; Cardiovascular Agents; Desoxycorticosterone; Drug Evaluation, Preclinical; Estradiol; Estrogens; Female; Hypertension; Nitric Oxide; Ovariectomy; Rats; Rats, Wistar; Sodium Chloride

An earlier study showed that des-aspartate-angiotensin I (DAA-I) attenuated the pressor action of angiotensin III in aortic rings of the spontaneously hypertensive rat (SHR) but not the normotensive Wistar Kyoto (WKY) rat. The present study investigated similar properties of DAA-I in isolated perfused kidneys and mesenteric beds of WKY and SHR. In the renal vasculature, angiotensin III induced a dose-dependent pressor response, which was more marked in the SHR than WKY in terms of significant greater magnitude of response and lower threshold. DAA-I attenuated the pressor action of angiotensin III in both the WKY and SHR. The attenuation in SHR was much more marked, occurring at doses as low as 10(-15) M DAA-I, while effective attenuation was only seen with 10(-9) M in WKY. The effects of DAA-I was not inhibited by PD123319 and indomethacin, indicating that its action was not mediated by angiotensin AT2 receptors and prostaglandins. However, the direct pressor action of angiotensin III in the SHR but not the WKY was attenuated by indomethacin suggesting that this notable difference could be due to known decreased response of renal vasculature to vasodilator prostaglandins in the SHR. Pressor responses to angiotensin III in the mesenteric vascular bed was also dose dependent, but smaller in magnitude compared to the renal response. The responses in the SHR, though generally smaller, were not significantly different from those of the WKY. This trend is in line with the similar observations with angiotensin III and II by other investigators. In terms of the effect of DAA-I, indomethacin and PD123319 on angiotensin III action, similar patterns to those of the renal vasculature were observed. This reaffirms that in the perfused kidney and mesenteric bed, where the majority of the vessels are contractile, femtomolar concentrations of DAA-I attenuates the pressor action of angiotensin III. The attenuation is not indomethacin sensitive and does not involve the angiotensin AT2 receptor. The findings suggest that DAA-I possesses protective vascular actions and is involved in the pathophysiology of hypertension.

Topics: Angiotensin I; Angiotensin II Type 2 Receptor Blockers; Angiotensin III; Animals; Blood Pressure; Blood Vessels; Cardiovascular Agents; Hypertension; Imidazoles; Indomethacin; Kidney; Male; Mesenteric Artery, Superior; Prostaglandins; Pyridines; Rats; Rats, Inbred SHR; Rats, Inbred WKY; Receptor, Angiotensin, Type 2; Vasoconstrictor Agents

Coronary heart disease (CHD) mortality is rising in many developing countries. We examined how much of the increase in CHD mortality in Beijing, China, between 1984 and 1999 could be attributed to changes in major cardiovascular risk factors and assessed the impact of medical and surgical treatments.. A validated, cell-based mortality model synthesized data on (1) patient numbers, (2) uptake of specific medical and surgical treatments, (3) treatment effectiveness, and (4) population trends in major cardiovascular risk factors (smoking, total cholesterol, blood pressure, obesity, and diabetes). Main data sources were the WHO MONICA and Sino-MONICA studies, the Chinese Multi-provincial Cohort Study, routine hospital statistics, and published meta-analyses. Age-adjusted CHD mortality rates increased by approximately 50% in men and 27% in women (1608 more deaths in 1999 than expected by application of 1984 rates). Most of this increase ( approximately 77%, or 1397 additional deaths) was attributable to substantial rises in total cholesterol levels (more than 1 mmol/L), plus increases in diabetes and obesity. Blood pressure decreased slightly, whereas smoking prevalence increased in men but decreased substantially in women. In 1999, medical and surgical treatments in patients together prevented or postponed approximately 642 deaths, mainly from initial treatments for acute myocardial infarction ( approximately 41%), hypertension (24%), angina (15%), secondary prevention (11%), and heart failure (10%). Multiway sensitivity analyses did not greatly influence the results.. Much of the dramatic CHD mortality increases in Beijing can be explained by rises in total cholesterol, reflecting an increasingly "Western" diet. Without cardiological treatments, increases would have been even greater.

Topics: Adult; Aged; Antihypertensive Agents; Aspirin; Cardiovascular Agents; China; Coronary Disease; Developing Countries; Diabetes Mellitus; Diet; Drug Utilization; Female; Humans; Hypercholesterolemia; Hypertension; Male; Middle Aged; Models, Cardiovascular; Mortality; Obesity; Risk Factors; Smoking

There is little information on the clinical and functional course of patients with heart failure secondary to dilated cardiomyopathy due to hypertension. The objectives of our study were to assess the clinical and functional course of these patients, and to identify possible predictors of prognosis.. We evaluated a series of 49 patients with this condition diagnosed in our hospital from 1994 to 2003. Mean age was 63(11) years, and 40% were women. Left ventricular ejection fraction was 30.1(4.8)%. Follow-up was 45(23) months (median, 41 months).. Four-year survival was 0.84, the 4-year rate of hospitalization due to heart failure was 0.12, and likelihood of readmission-free survival was 0.80 at 4 years. Left ventricular ejection fraction increased from 30.1(4.8)% to 57.6(13.5)% (P< .001). An unfavorable clinical and functional outcome at 4 years (death, readmission for heart failure or persistence of dilated cardiomyopathy) was recorded in only in 40% of the patients. Multivariate analysis with the Cox model showed appropriate control of blood pressure to be the only independent predictor of a favorable clinical outcome (absence of death or readmission for heart failure) (hazard ratio = 4.58; 95% CI, 1.32-9.83; P=.032).. The course of patients with severe dilated cardiomyopathy due to hypertension was favorable in 60% of cases. Adequate control of blood pressure was the only independent predictor of a favorable clinical outcome.

Topics: Cardiomyopathy, Dilated; Cardiovascular Agents; Female; Heart Failure; Humans; Hypertension; Male; Middle Aged; Multivariate Analysis; Prognosis; Recovery of Function; Survival Analysis; Systole; Treatment Outcome; Ventricular Dysfunction, Left

Treatment of chronic heart failure is based on the results of large clinical trials, which form the basis of treatment guidelines, such as those from the European Society of Cardiology (ESC). The aim of this study was to record treatment-modalities and the implementation of guidelines of chronic heart failure in clinical practice in Austria.. Overall 96 general physicians, specialists for internal medicine in private practice or in hospital outpatient departments participated in the survey. Physicians were asked to prospectively document 30 consecutive patients with chronic heart failure.. 1880 patients were documented. The majority of patients were treated by general physicians (57%). Coronary artery disease was the most frequent aetiology for heart failure (47%). The most frequently used drugs were blockers of the renin-angiotensin-system (RAS-blocker including ACE-inhibitors and angiotensin-receptor-blockers, 78%), diuretics (76%) and beta-blockers (49%). Other drugs like digitalis and spironolactone were used infrequently. Average doses of ACE-inhibitors were approximately 90% of those recommended by the ESC, average doses of beta-blockers were approximately 50% of those recommended. Treatment among the three classes of physicians differed with respect to RAS-blockers and beta-blockers, which were used infrequently by general practitioners. Both groups of drugs were given more frequently to younger patients (<70 years) while digitalis was given more often to elderly patients.. Results from this survey suggest that Austrian physicians treating patients with heart failure use the appropriate drugs in dosages that are suggested by recently published guidelines (ACE-inhibitors and beta-blockers). However, dosages of spironolactone clearly differed from current recommendations.

Topics: Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Austria; Cardiovascular Agents; Chronic Disease; Clinical Trials as Topic; Coronary Artery Disease; Diuretics; Dose-Response Relationship, Drug; Female; Heart Failure; Humans; Hypertension; Male; Medical Records; Middle Aged; Practice Guidelines as Topic; Practice Patterns, Physicians'; Prospective Studies

Topics: Aldosterone; Cardiovascular Agents; Cardiovascular Physiological Phenomena; Heart Diseases; Humans; Hyperaldosteronism; Hypertension; Mineralocorticoid Receptor Antagonists

Atherothrombosis is a systemic disease affecting coronary, cerebral, and lower limb arteries, and requiring secondary prevention measures.. Data from three observational studies carried out in 1999-2000 (ECLAT1, APRES, PRISMA) were pooled to describe the prevalence of cardiovascular risk factors and the patterns of drug use in atherothrombotic patients.. General practitioners and cardiologists engaged in a private practice and evenly distributed in France recruited consecutive patients who had a history of at least one atherothrombotic event: myocardial infarction (MI), ischaemic stroke, and/or peripheral arterial disease (PAD).. The sample was composed of 14 544 patients (men: 75.0%, age 75 or older: 31.0%). At least one of the four major risk factors (smoking, hypertension, hypercholesterolaemia, diabetes) was present in 94.3% of the sample. Prevalence of drug use was: 78.8% (antiplatelet agents), 48.5% (statins), 36.7% (beta-blockers), and 33.4% [angiotensin-converting enzyme (ACE) inhibitors]. After adjustment for confounders, statins were taken in a significantly larger extent in patients with a history of isolated MI than in those with a previous ischaemic stroke or PAD, or in patients who suffered from both MI and ischaemic stroke. Isolated MI (as compared with ischaemic stroke and PAD) was significantly and independently associated with a higher probability to take antiplatelet agents, beta-blockers or ACE inhibitors.. At least one conventional risk factor was observed in almost all atherothrombotic patients. Use of preventive drugs was lower in patients with a history of ischaemic stroke or PAD, and should increase, accordingly to the results of recent randomized controlled trials.

Topics: Adult; Aged; Brain Ischemia; Cardiovascular Agents; Diabetes Mellitus, Type 2; Female; France; Humans; Hypercholesterolemia; Hypertension; Life Style; Male; Middle Aged; Myocardial Infarction; Peripheral Vascular Diseases; Prevalence; Risk Factors; Smoking; Stroke

The information on the existence of sex differences in management of stroke patients is scarce. We evaluated whether sex differences may influence clinical presentation, resource use, and outcome of stroke in a European multicenter study.. In a European Concerted Action involving 7 countries, 4499 patients hospitalized for first-in-a-lifetime stroke were evaluated for demographics, risk factors, clinical presentation, resource use, and 3-month survival, disability (Barthel Index), and handicap (Rankin Scale).. Overall, 2239 patients were males and 2260 females. Compared with males, female patients were significantly older (mean age 74.5+/-12.5 versus 69.2+/-12.1 years), more frequently institutionalized before stroke, and with a worse prestroke Rankin score (all values P<0.001). History of hypertension (P=0.007) and atrial fibrillation (P<0.001) were significantly more frequent in female stroke patients, as were coma (P<0.001), paralysis (P<0.001), aphasia (P=0.001), swallowing problems (P=0.005), and urinary incontinence (P<0.001) in the acute phase. Brain imaging, Doppler examination, echocardiogram, and angiography were significantly less frequently performed in female than male patients (all values P<0.001). The frequency of carotid surgery was also significantly lower in female patients (P<0.001). At the 3-month follow-up, after controlling for all baseline and clinical variables, female sex was a significant predictor of disability (odds ratio [OR], 1.41; 95% CI 1.10 to 1.81) and handicap (OR, 1.46; 95% CI 1.14 to 1.86). No significant gender effect was observed on 3-month survival.. Sex-specific differences existed in a large European study of hospital admissions for acute stroke. Both medical and sociodemographic factors may significantly influence stroke outcome. Knowledge of these determinants may positively impact quality of care.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alcohol Drinking; Atrial Fibrillation; Brain Damage, Chronic; Brain Ischemia; Cardiovascular Agents; Case Management; Comorbidity; Diabetes Mellitus; Diagnostic Imaging; Europe; Female; Follow-Up Studies; Glasgow Coma Scale; Humans; Hypertension; Hypoglycemic Agents; Institutionalization; Length of Stay; Male; Middle Aged; Myocardial Infarction; Patient Discharge; Prognosis; Registries; Risk Factors; Severity of Illness Index; Sex Factors; Smoking; Stroke; Stroke Rehabilitation; Subarachnoid Hemorrhage; Survival Analysis; Treatment Outcome

An enhanced sensitivity to angiotensin II in the renal circulation has been demonstrated in the pre-hypertensive phase both in the spontaneously hypertensive rat and in man. To further characterize this abnormality and the role of prostanoids, renal haemodynamics in normotensive young men with a positive (PFH) or a negative (NFH) family history of hypertension were studied.. Renal vascular reactivity was assessed during infusion of angiotensin II with and without inhibition of prostaglandin synthesis. Normotensive men with PFH (n = 13) and with NFH (n = 10) with a mean age of 38 years were given on two different occasions: (i). angiotensin II infusion i.v. (0.1, 0.5 and 1.0 ng/kg per min) and (ii). angiotensin II infusion after inhibition of prostaglandin synthesis with indomethacin (150 mg daily three consecutive days). Glomerular filtration rate (GFR) and renal plasma flow were measured with renal clearances of chromium edetic acid and para-aminohippuric acid.. Before angiotensin II challenge, the groups did not differ with respect to blood pressure, body mass index, plasma renin activity, GFR, renal blood flow (RBF) or urinary sodium excretion. There was no significant difference in systolic or diastolic blood pressure response to angiotensin II between the two groups. In PFH, the lowest angiotensin II dose caused a significant decrease in RBF and increase in renal vascular resistance (RVR) from baseline (P < 0.01 for both). In NFH, only the highest angiotensin II dose produced a significant decrease in RBF and increase in RVR (P < 0.01 for both). During inhibition of prostaglandin synthesis, all three angiotensin II doses caused a significant decrease in RBF (P < 0.02) and increase in RVR (P < 0.02) also in NFH. The renal haemodynamic difference between PFH and NFH was thus eliminated.. These findings indicate that young human subjects with a positive family history of hypertension have a defective vasodilator prostaglandin system, which is responsible for increased renal vascular sensitivity to angiotensin II. Enhanced renal vasoconstriction may be an early event leading to the generation of primary hypertension.

Topics: Adult; Angiotensin II; Blood Pressure; Body Mass Index; Cardiovascular Agents; Diastole; Dose-Response Relationship, Drug; Genetic Predisposition to Disease; Glomerular Filtration Rate; Heart Rate; Humans; Hypertension; Indomethacin; Infusions, Intravenous; Kidney; Male; Prostaglandin-Endoperoxide Synthases; Prostaglandins; Regional Blood Flow; Renin; Statistics as Topic; Systole; Vascular Resistance; Vasoconstrictor Agents

The role of systemic hypertension in acute coronary syndrome (ACS) has not been well studied. We studied consecutive subjects admitted to the University of Michigan Health System (Ann Arbor, Michigan) with symptoms of ACS. Data were collected using a standardized form. This observational study is currently ongoing; we collected data from May 1999 to December 2000 for 979 subjects, 890 of whom also had 6-month follow-up data. Hypertensives represented 64.4% (n = 630) of the total population. In general, hypertensive patients were older than normotensives (66.3 vs 59.9 years, p <0.0001), more often women (38.7% vs 26.9%, p = 0.0002), and had more comorbidities, such as previous myocardial infarction (47.9% vs 33.8%, p <0.0001), congestive heart failure (25.7% vs 12.0%, p <0.0001), and diabetes (36.9% vs 17.8%, p <0.0001). At admission, hypertensives had higher systolic blood pressure. Hypertensives had fewer electrocardiographic abnormalities indicating ischemic changes (67.9% vs 76.3%, p = 0.01) and had fewer incident of acute myocardial infarction (AMI) (70.7% vs 76.1%, p = 0.07) than normotensives. There was consistency over different levels of admission systolic blood pressure. Hypertensives received more oral cardiovascular drugs, and had undergone more invasive procedures. The lower rate of AMI in hypertensives seemed to be related to the higher frequency of a history of percutaneous coronary intervention and coronary artery bypass grafting. However, at 6-month follow-up, age- and gender-adjusted odds ratios for adverse events were equivalent in hypertensives and normotensives, suggesting no continuing differential treatment benefit for hypertensives in the months after the initial ACS episode.

Topics: Acute Disease; Age Distribution; Aged; Biomarkers; Cardiovascular Agents; Comorbidity; Coronary Disease; Creatine Kinase; Electrocardiography; Female; Follow-Up Studies; Humans; Hypertension; Male; Michigan; Middle Aged; Myocardial Infarction; Odds Ratio; Reference Values; Regression Analysis; Sex Distribution; Syndrome; Troponin I

The cardiovascular protective effects of the traditional Chinese medicine Bak Foong Pills (BFP) were investigated. Spontaneously hypertensive rats (SHR) were treated (3 g/kg) over a 5-month period and blood pressure measurements periodically tested with a plethysmographic tail cuff. Following treatment, blood samples were analysed for serum electrolyte levels and lipid levels and brain tissue subjected to micro-array analysis. In vitro experiments were also conducted to identify possible direct vasorelaxatory effect. The results showed that BFP was able to significantly reduce both systolic and diastolic blood pressure by about 30 mmHg in SHR following 5 months of treatment, when compared to untreated animals. Investigation for possible mechanisms of actions revealed that BFP treated rats had elevated blood serum K(+) levels, and also demonstrated decreased serum triglyceride levels. Micro-array analysis of brain tissue showed altered expression of acetylcholine and lysosphingolipid receptor genes that are known to regulate blood pressure. In vitro experiments also showed that BFP caused a concentration-dependant vasorelaxation of isolated rat aortae when contracted with phenylepherine, which was partially inhibited by nitric oxide synthase inhibitor L-NAME (100 microM). These data suggest that BFP is able to significantly reduce hypertension in SHR through mechanisms probably involving a combination of increased serum K(+), vasorelaxatory action, reduced serum triglyceride and altered gene regulation in the higher centres.

Topics: Animals; Blood Pressure; Cardiovascular Agents; Dose-Response Relationship, Drug; Drugs, Chinese Herbal; Hypertension; In Vitro Techniques; Male; Medicine, Chinese Traditional; Muscle, Smooth, Vascular; Rats; Rats, Inbred SHR

Relevant national societies attribute special importance to the secondary prevention of coronary patients. This is well formulated in their recommendations (9, 11). Actual clinical practice was studied in 1995-1996 by the EUROASPIRE I study. Its Hungarian data were published in 1999 (8). The scope of EUROASPIRE II in 1999-2000 was to study changes occurred in these 5 years. In this paper the authors intend to answer the question whether the clinical practice of secondary prevention of coronary patients showed any changes at the turn of the millennium. Participating centres, the criteria of patient selection and the applied methods were identical in the two studies. Hospital data of 516 patients below the age of 70 were analysed. There was no difference between the two studies neither in the distribution according to gender and age, nor in the number of death. Documentation of the relevant data in the hospital records improved substantially: blood pressure was registered in every patient chart, lipid values in 91%. Information on smoking however is still missing in 1/3 of the patients, while on weight and height in half of them. The response rate at the follow up investigation on was 75%. The prevalence of obesity increased by 60%, that of smoking by 13% since the first investigation 5 years ago. This rate of increase is the largest among the 9 participating centres. The prevalence of hypertension decreased by 24.5% and the proportion of hypertensive patients receiving treatment increased by 7%. In spite of these blood pressure values over 140/90 mmHg were found in 37% of the patients. The mean triglyceride value increased by 53% and the prevalence of severe hypercholesterolaemia by 43%. Lipid lowering drugs are given to 51% of the patients in contrast to 22% 5 years earlier. In spite of this cholesterol values above 5.5 mmol/l were found in 42%. In respect of prophylactic drugs the proportion of patients receiving beta blockers increased from 58 to 84%.. The evaluation of complex risk of patients and their long-term care is still deficient. Drug treatment improved quantitatively but not qualitatively. This and the lack of lifestyle-improving medical efforts is reflected by the increase of the proportion of obese and smoking patients and the persistently high prevalence of hypercholesterolaemia and hypertension.

Topics: Age Distribution; Aged; Angioplasty, Balloon, Coronary; Blood Pressure; Cardiovascular Agents; Clinical Trials as Topic; Coronary Artery Bypass; Coronary Disease; Female; Humans; Hungary; Hypercholesterolemia; Hypertension; Incidence; Life Style; Lipids; Male; Middle Aged; Myocardial Infarction; Obesity; Retrospective Studies; Risk Factors; Sex Distribution; Smoking

Topics: Advisory Committees; Aspirin; Cardiovascular Agents; Cardiovascular Diseases; Drug Packaging; Drug Therapy, Combination; Humans; Hypertension; Pravastatin

Coronary artery disease (CAD) is the leading cause of adult deaths in our country. In clinical practice, an adequate level of secondary prevention towards CAD primarily requires full recognition of the distribution of risk factors. The aim of our study was to determine the prevalence of coronary risk factors and the use of prophylactic drugs among patients who have an angiographically proven CAD in our centre, and to compare it with those of the EUROASPIRE I and II studies.. Cross-sectional, observational study.. Our patients comprise 617 subjects (516 male, mean age 57.2 +/- 10.8 years) who underwent an angiography between January 2000 and May 2000 for the first time and in whom significant coronary lesions were detected. Age, gender, family history of premature CAD (FH), diabetes mellitus (DM), hypertension (HT), lipid profile, smoking, body mass index, waist circumference, hip circumference and physical activity data were recorded prior to angiography. The medical treatments received by these cases at discharge from hospital were investigated. Data thus obtained were compared with the results of the EUROASPIRE I and II trials, which studied the frequency of existing risk factors and prophylactic drug use among CAD patients in European countries.. Hyperlipidaemia, FH, DM, HT, smoking, obesity, central obesity were found in 52, 26, 20, 41, 65, 18 and 29% of patients, respectively. The use of antiplatelets, beta-blockers, ACE inhibitors, statins and calcium antagonists were 99, 86, 40, 63 and 16%, respectively.. Upon comparison of the risk factors, prevalence of obesity and DM was found to be similar to the average of nine European countries among our subjects. Smoking was found to be considerably higher, whereas HT, hyperlipidaemia and family history of premature CAD were lower than the European average within our subjects. In our cases the frequency of prophylactic drug usage at discharge was higher than the European means.

Topics: Adult; Aged; Anticipation, Genetic; Cardiovascular Agents; Chemoprevention; Coronary Angiography; Coronary Artery Disease; Cross-Sectional Studies; Epidemiologic Factors; Exercise; Female; Hematologic Agents; Humans; Hypertension; Male; Metabolic Diseases; Middle Aged; Obesity; Observation; Prevalence; Risk Factors; Smoking; Turkey

To evaluate whether the elevated blood pressure induced by chronic treatment with N(omega)-nitro-L-arginine methyl ester (L-NAME) contributes to an impairment of endothelium-dependent relaxation (EDR), the effects of chronic treatment of Wistar rats with L-NAME on systolic blood pressure, pulmonary arterial blood pressure and EDR of the pulmonary arteries were studied and compared with those of stroke-prone spontaneously hypertensive rats (SHRSP). While the systolic blood pressure (SBP) of Wistar rats was increased above that of controls by chronic treatment with L-NAME, it was still significantly lower than that of SHRSP. Chronic treatment with L-NAME did not affect pulmonary arterial blood pressure. On the other hand, the pulmonary arterial blood pressure of SHRSP was slightly but significantly higher than that of the control normotensive Wistar Kyoto rats (WKY). EDR in response to acetylcholine in the pulmonary artery of L-NAME-treated rats was significantly smaller than that in control Wistar rats. The EDR markedly increased in the presence of L-arginine and completely disappeared in the presence of N(omega)-nitro-L-arginine. Indomethacin hardly affected EDR. In preparations from SHRSP, the EDR was not different from that in those from WKY. Relaxation induced by sodium nitroprusside was identical in all preparations. Elevation of SBP and the impairment of EDR observed in L-NAME-treated rats recovered two weeks following cessation of treatment. These results suggest that the impaired EDR in the pulmonary artery of L-NAME-treated rats is not due to an L-NAME-induced increase in blood pressure but due to the inhibition of nitric oxide synthase by the drug remaining in the endothelium.

Topics: Animals; Arginine; Blood Pressure; Body Weight; Cardiovascular Agents; Endothelium, Vascular; Enzyme Inhibitors; Genetic Predisposition to Disease; Hypertension; Indomethacin; Male; NG-Nitroarginine Methyl Ester; Nitric Oxide Donors; Nitroarginine; Nitroprusside; Pulmonary Artery; Rats; Rats, Inbred SHR; Rats, Inbred WKY; Rats, Wistar; Stroke; Vasodilation

To determine the prevalence of stroke risk factors in a general practice population and to identify pharmacotherapies currently used in management of stroke risk factors.. Multicentre, observational study by 321 randomly selected general practitioners who each collected data on 50 consecutive patients attending their surgery.. 16 148 patients aged 30 years or older attending general practices across Australia during 2000.. Prevalence of hypertension, current smoking, diabetes, hypercholesterolaemia, atrial fibrillation, recent history of stroke or TIA; extent of pharmacotherapy use in risk-factor management.. 70% of patients had one or more risk factors and 34% had two or more. Hypertension was the risk factor with greatest prevalence (44%), followed by hypercholesterolaemia (43%) and current smoking (17%). The prevalence of risk factors generally increased with age, except for current smoking, where a decrease with age was seen. The most common pharmacotherapies were cardiovascular agents, followed by antiplatelet agents. Two-thirds of patients with hypertension were taking cardiovascular drugs, most commonly angiotensin-converting enzyme inhibitors.. Stroke risk factors are highly prevalent in general practice patients and GPs are ideally placed for opportunistic case-finding. There is considerable scope for improving management of stroke risk factors. The Avoid Stroke as Soon as Possible (ASAP) general practice stroke audit provides a baseline against which progress in risk-factor management can be measured.

Topics: Adult; Aged; Aged, 80 and over; Australia; Cardiovascular Agents; Diabetes Mellitus; Family Practice; Female; Hematologic Agents; Humans; Hypercholesterolemia; Hypertension; Hypoglycemic Agents; Male; Medical Audit; Middle Aged; Multicenter Studies as Topic; Prevalence; Risk Factors; Stroke

To evaluate the implementation of secondary prevention and treatment of coronary heart disease (CHD) in general practice in Iceland.. Two health care centers adjacent to Reykjavik with a total of 25766 inhabitants.. All patients (533) with CHD living in the study area were sent an invitation letter and a request for informed consent. Those who chose to participate answered a questionnaire about CHD risk factors and their current treatment, and their medical records were reviewed. The patients were divided into four groups on the basis of their history: I. Coronary artery bypass surgery (CABG), II. Percutaneous transluminal coronary angioplasty (PTCA), III. Myocardial infarction (MI), IV. Angina pectoris (AP). If a patient fulfilled the criteria for more than one diagnostic group the CABG group had the highest priority followed by PTCA, MI and finally AP.. Blood pressure, smoking habits, BMI, exercise profile, cholesterol levels and drug therapy.. Of 533 patients with CHD, 402 (75%) participated in the study, 15% were managed exclusively by their family physician and 23% by both cardiologists and family physicians. Obesity was relatively common, with nearly 60% being overweight (BMI > 25). Average cholesterol in the total group was 6.2 mmol/L (95% CI 6.07 to 6.34). Blood pressure had been recorded in 92% of the patients, and mean systolic and diastolic blood pressures were 143 and 82 mmHg, respectively. While 15% were current smokers, 56% were ex-smokers. A total of 113 patients (28%) were being treated with cholesterol-lowering drug therapy at the time of the study. Respective treatment ratios in the four subgroups were 47% in group I, 42% in II, 25% in III and 13% in group IV. Aspirin was taken by 284 patients (71%), beta blockers by 52% and calcium channel blockers by 36%. More than twice as many women than men were treated with nitrates, 57% versus 27%.. The results indicate that there are numerous possibilities for improvements in secondary prevention and medical management of coronary heart disease in Iceland. Particular emphasis should be placed on smoking cessation, life-style modification with exercise and diet recommendations to lower BMI and lipid-lowering therapy.

Topics: Angioplasty, Balloon, Coronary; Anticholesteremic Agents; Cardiovascular Agents; Combined Modality Therapy; Coronary Artery Bypass; Coronary Disease; Drug Utilization; Exercise; Family Practice; Female; Health Care Surveys; Humans; Hypertension; Iceland; Male; Needs Assessment; Obesity; Practice Patterns, Physicians'; Primary Health Care; Primary Prevention; Risk Factors; Smoking

Cardiovascular disease (CVD) is a major cause of morbidity and mortality among patients with chronic renal insufficiency (CRI). beta-Adrenergic blockers, acetylsalicylic acid (ASA), angiotensin-converting enzyme (ACE) inhibitors, and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) all reduce CVD mortality, but little is known about the extent to which these medications are used in patients with CRI. This study, a prospective cross-sectional study of consecutive patients seen by nephrologists in four Canadian centers for follow-up of progressive CRI in 1999, was performed to investigate the prevalence of coronary risk factors and use of cardioprotective medications among patients with CRI. Patients had creatinine clearances of 75 mL/min or less but were not on dialysis therapy. Three hundred four consecutive patients meeting the inclusion criteria were enrolled. Mean age was 60.8 +/- 15.7 years, mean creatinine clearance was 30.3 +/- 18 mL/min, and the case mix of kidney diseases was similar to that in the Canadian Organ Replacement Registry data. One hundred seventeen of 304 patients (38.5%) had a history of previous CVD, and the prevalence of CVD was greater in patients with more severe CRI. Two hundred forty-three patients (79.9%) had a history of hypertension, 132 patients (43.4%) had hyperlipidemia, 114 patients (37.5%) had diabetes mellitus, and 71 patients (27.3%) were smokers. Thirty-five percent of the patients with CVD had blood pressures greater than 140/90 mm Hg; 103 patients (33.9%) were administered beta-blockers; 196 patients (64.5%), ACE inhibitors or angiotensin-receptor blockers; 83 patients (27.3%), ASA; and 56 patients (18.4%), statins. Patients with diabetes were not more likely than those without diabetes to be prescribed cardioprotective medications. CVD is common in the predialysis population, and its prevalence increases with more severe kidney failure. Despite this, the use of cardioprotective medications is relatively low, and many patients had suboptimal blood pressure control. Given the high burden of disease in these patients, beta-blockers and ACE inhibitors should be used to control hypertension and/or for cardioprotection, and the increased use of ASA and statins should be considered.

Topics: Adult; Aged; Canada; Cardiovascular Agents; Cardiovascular Diseases; Creatinine; Cross-Sectional Studies; Diabetes Complications; Female; Follow-Up Studies; Humans; Hypertension; Kidney Failure, Chronic; Male; Middle Aged; Prevalence; Prospective Studies; Regression Analysis; Risk Factors

Interferon-alpha (IFN-alpha) has been widely used for treatment of chronic hepatitis C in Japan. In general, cardiovascular adverse reactions are rare in association with IFN-alpha therapy. Here, a 64-year-old man with chronic active hepatitis C complained of fatigue, palpitation and depression, and developed atrial fibrillation with prominent negative T waves during IFN-alpha therapy. Echocardiogram showed septal and apical hypertrophy. Three days after discontinuation of IFN-alpha, subjective symptoms and atrial fibrillation subsided. It is unclear whether or not IFN-alpha induced the giant negative T waves with apical hypertrophy. We might observe the developing course of hepatitis C virus (HCV)-related myocardial hypertrophy by chance. Cardiovascular toxicity should be carefully monitored during IFN-alpha therapy even in patients with minor cardiac disease, such as premature ventricular contracture (PVC) and mild hypertension.

Topics: Antihypertensive Agents; Antiviral Agents; Atrial Fibrillation; Atrial Premature Complexes; Cardiovascular Agents; Electrocardiography; Hepatitis C, Chronic; Humans; Hypertension; Hypertrophy, Left Ventricular; Interferon alpha-2; Interferon-alpha; Male; Middle Aged; Recombinant Proteins; Tachycardia; Ultrasonography

Two currently available edible oils-olive and canola-and two oil blends of plant origin having different n-3/n-6 polyunsaturated fatty acid (PUFA) ratios were evaluated for their ability to modify vascular dysfunction in the spontaneously hypertensive rat (SHR). Synthetic diets supplemented with test oils (5% w/w) were fed for 12 weeks, and segments of thoracic aorta used to assess vascular function. Vessels from the SHR displayed a spontaneous constrictor response after the inhibition of endothelial cell nitric oxide (NO) with N(omega)-nitro-L-arginine (NOLA). Dietary alpha -linoleate enrichment led to a reduction (P<0.05) in this abnormality with a dietary n-3/n-6 PUFA ratio of 1.0 (blend-1) yielding the best outcome. Relaxation to acetylcholine (ACh) was unaffected by dietary lipid supplementation. NOLA treated rings also displayed contractions to ACh that were abolished by indomethacin, thromboxane antagonists SQ29548, picotamide and flavonoids kaempferol and quercetin. In contrast, alpha-tocopherol, rutin and the lipoxygenase inhibitor esculetin resulted in only partial (30-55%) inhibition, and were ineffective against the NOLA-induced contraction suggesting the operation of different biochemical mechanisms in mediating the spontaneous and Ach-induced contractions. Results implicate plant-based oils and antioxidants as potential modulators of vascular function.

Topics: Acetylcholine; alpha-Tocopherol; Animals; Antioxidants; Aorta; Bridged Bicyclo Compounds, Heterocyclic; Cardiovascular Agents; Diet; Dose-Response Relationship, Drug; Endothelium, Vascular; Fatty Acids, Unsaturated; Flavonoids; Hydrazines; Hypertension; Indomethacin; Kaempferols; Lipid Metabolism; Nitric Oxide; Phthalic Acids; Plant Oils; Platelet Aggregation Inhibitors; Quercetin; Rats; Rats, Inbred SHR; Rutin; Umbelliferones

Omapatrilat is a newly developed vasopeptidase inhibitor that inhibits both angiotensin-converting enzyme (ACE) and neutral endopeptidase and has potent antihypertensive efficacy. However, the specific effect of omapatrilat on cardiac function and left ventricular hypertrophy with hypertension remains controversial. Therefore, we investigated the effect of omapatrilat on blood pressure, cardiac hypertrophy, and cardiac function in spontaneously hypertensive rats (SHR). Studies were performed in SHR that received vehicle (n = 9), omapatrilat (n = 10), or fosinopril (ACE inhibitor, n = 7) by daily gavage for 56 days. Systolic blood pressure (SBP) and mean blood pressure (MBP) were measured by tail plethysmography. Left ventricular fractional shortening and left ventricular mass were measured by echocardiography at day 56. Omapatrilat and fosinopril significantly decreased SBP and MBP from day 1 through day 56, and omapatrilat markedly reduced SBP and MBP compared with fosinopril from day 21 to day 56. Although both omapatrilat and fosinopril decreased left ventricular mass and left ventricular mass-to-body weight ratio with increased LV fractional shortening, omapatrilat had a more potent effect on the reduction of left ventricular mass and improvement of cardiac function. This study shows that in SHR, omapatrilat mediated a potent and stable antihypertensive effect and a reduction in left ventricular mass with improvement of cardiac function, compared with ACE inhibition alone.

Topics: Angiotensin-Converting Enzyme Inhibitors; Animals; Blood Pressure; Cardiovascular Agents; Endocardium; Fosinopril; Hemodynamics; Hypertension; Hypertrophy, Left Ventricular; Male; Pyridines; Rats; Rats, Inbred SHR; Thiazepines; Ventricular Function, Left

(1) Omapatrilat, first in a new class of cardiovascular drugs called vasopeptidase inhibitors, is under evaluation for the management of hypertension and heart failure. (2) Several small trials have demonstrated the efficacy and tolerability of once-daily omapatrilat in the treatment of mild to moderate hypertension. Efficacy data from one medium-sized trial have demonstrated a benefit comparable to lisinopril in the treatment of systolic heart failure. (2) The benefits and risks of omapatrilat as compared to ACE inhibitors are under evaluation and could affect future clinical therapy guidelines for managing hypertension and heart failure.

Topics: Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Cardiovascular Agents; Clinical Trials as Topic; Drug Evaluation; Heart Failure; Humans; Hypertension; Lisinopril; Pyridines; Technology Assessment, Biomedical; Thiazepines; Treatment Outcome

Changes in hemorheological parameters were studied in patients with ischemic cerebrovascular disease and elderly healthy men who ingested ethanol at 0.5 and 1 g/kg body weight. Following ingestion of 1 g/kg, but not 0.5 g/kg of ethanol, there were significant changes in hemorheologic factors. Whole blood viscosity (WBV, shear rate: 18.8, 37.5, 75, 150, 350 sec(-1)) and blood viscosity corrected for hematocrit (BVC) were increased. WBV and BVC at high shear rate were increased and red blood cell deformability impaired in patients with ischemic cerebrovascular disease, while those factors were not significantly changed in healthy men. It is considered that ethanol ingestion could has bad influences for the microcirculation in patients with ischemic cerebrovascular disease.

Topics: Acetaldehyde; Aged; Alcohol Drinking; Blood Proteins; Blood Viscosity; Brain Ischemia; Cardiovascular Agents; Cerebral Infarction; Diuresis; Dose-Response Relationship, Drug; Erythrocyte Deformability; Ethanol; Hematocrit; Hemodynamics; Hemorheology; Humans; Hyperlipidemias; Hypertension; Male; Microcirculation; Middle Aged

Volume expansion and inotropic stimulation are used clinically to augment cardiac output during acute right ventricular (RV) pressure overload. We previously showed that a brief period of RV pressure overload causes RV free wall dysfunction that persists after normal loading conditions have been restored. However, the impact of volume expansion and inotropic stimulation on the severity of RV dysfunction after acute pressure overload is unknown. We hypothesized that the severity of RV dysfunction after RV pressure overload would be related to the level of RV free wall systolic stress during RV pressure overload, rather than to the specific interventions used to augment RV function. Chloralose-anesthetized, open-chest pigs were subjected to 1 h of RV pressure overload caused by pulmonary artery constriction, followed by 1 h of recovery after release of pulmonary artery constriction. A wide range of RV free wall systolic stress during RV pressure overload was achieved by either closing or opening the pericardium (to simulate volume expansion) and by administering or not administering dobutamine. The severity of RV free wall dysfunction 1 h after RV pressure overload was strongly and directly correlated with the values of two hemodynamic variables during RV pressure overload: RV free wall area at peak RV systolic pressure (determined by sonomicrometry) and peak RV systolic pressure, two of the major determinants of peak RV free wall systolic stress. Opening or closing the pericardium, and using or not using dobutamine during RV pressure overload, had no independent effects on the severity of RV dysfunction. The findings suggest that the goal of therapeutic intervention during RV pressure overload should be to achieve the required augmentation of cardiac output with the smallest possible increase in RV free wall systolic stress.

Topics: Animals; Atropine; Cardiac Catheterization; Cardiotonic Agents; Cardiovascular Agents; Diastole; Dilatation, Pathologic; Disease Models, Animal; Dobutamine; Female; Heart; Hemodynamics; Hexamethonium; Hypertension; Linear Models; Pericardium; Pulmonary Artery; Swine; Systole; Ventricular Dysfunction, Right

Gastric mucosal-arterial PCO2 gradient (P(g-a)CO2) is used to assess splanchnic perfusion and oxygenation. We evaluated whether P(g-a)CO2 reflects whole body (Q) and splanchnic (Qsp) blood flow, oxygen delivery (DO2) and consumption (VO2) after coronary artery by pass graft (CABG) operation. Thirty patients received dobutamine or dopexamine to increase cardiac index, 15 patients enalapril or sodium nitroprusside to lower blood pressure, and 30 patients were controls. We measured Q, Qsp (hepatic vein catheter and indocyanine green), and gastric mucosal PCO2 (nasogastric tonometer) before and after interventions. Multiple linear regression model showed that none of the changes in Q, Qsp, and splanchnic or systemic DO2 and VO2 significantly explained changes in P(g-a)CO2 (deltaP(g-a)CO2). All independent variables together explained only 7% of deltaP(g-a)CO2. Increased splanchnic blood flow (0.65 +/- .19 vs. 0.94 +/- .31 L/min/m2, P < 0.001) and increased splanchnic DO2 (101 +/- 28 vs. 143 +/- 42 mL/min/m2, P < 0.001) during catecholamine infusions were associated with increased P(g-a)CO2 (8 +/- 8 vs. 11 +/- 7 mmHg, P = 0.003). P(g-a)CO2 does not reflect whole body or splanchnic blood flow, DO2 or VO2 after CABG operations. The physiology of P(g-a)CO2 is complex and therefore it is difficult for clinicians to interpret changes in gastric mucosal-arterial PCO2 gradient in individual patients after cardiac surgery.

Topics: Antihypertensive Agents; Arteries; Carbon Dioxide; Cardiovascular Agents; Catecholamines; Coronary Artery Bypass; Dobutamine; Dopamine; Enalapril; Gastric Mucosa; Hemodynamics; Histamine H2 Antagonists; Humans; Hydrogen-Ion Concentration; Hypertension; Nitroprusside; Oxygen; Oxygen Consumption; Partial Pressure; Postoperative Period; Splanchnic Circulation; Vasodilator Agents

SB 209670 is a potent antagonist of the vasoconstrictor (ET(A)- and ET(B)-receptor-mediated) and vasodilator (ET(B)-receptor-mediated) effects of endothelin, whereas SB 234551 is relatively selective for the constrictor (ET(A)-receptor-mediated) effects. Since we had previously found SB 209670 exerted antihypertensive, vasodilator effects in conscious, heterozygous, transgenic ((mRen-2)27) (abbreviated to TG) rats, here we compared the two antagonists in that model, and assessed their chronic effects on responses to exogenous endothelin-1. We did this to test our global hypothesis, namely, that SB 209670, but not SB 234551, would cause inhibition of the depressor effects of exogenous endothelin-1 in vivo, and that this differential effect would be associated with a more marked antihypertensive action of SB 234551 in TG rats. SB 209670 and SB 234551 (infused for 50 h) exerted similar, sustained, antihypertensive effects in TG rats. The antihypertensive effects of the antagonists occurred at times when the pressor effects of exogenous endothelin-1 were not significantly inhibited. Furthermore, SB 234551 did not exert a greater antihypertensive effect than SB 209670 at a time (i.e., 2 - 4 h) when the depressor effects of endothelin-1 were abolished by the latter, but not by the former (although this differential action was lost after 24 h infusion). The results caused us to reject the hypothesis that selective antagonism of the vasoconstrictor effects of endothelin-1 would result in SB 234551 exerting a greater antihypertensive effect than SB 209670 in TG rats.

Topics: Anesthetics; Animals; Animals, Genetically Modified; Baroreflex; Blood Pressure; Butyrophenones; Cardiovascular Agents; Consciousness; Dioxoles; Dose-Response Relationship, Drug; Drug Combinations; Endothelin Receptor Antagonists; Endothelin-1; Female; Fentanyl; Heart; Heart Rate; Humans; Hypertension; Indans; Male; Medetomidine; Methohexital; Mice; Midazolam; Pyrazoles; Rats; Rats, Sprague-Dawley; Renin; Time Factors

Three guidelines have been selected for this review: The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VI), the 1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension (WHO/ISH) and the Guidelines for management of hypertension: report of the third working party of the British Hypertension Society (BHS). The guidelines are generally in accordance on the principles of drug prescribing. There is, however, a serious divergence of opinion between JNC VI and BHS, and WHO/ISH on the levels of blood pressure chosen for defining hypertension and the level to which blood pressure should be reduced. In defining hypertension using ambulatory blood pressure measurement (ABPM), JNC VI and BHS recommendations for systolic blood pressure are 10-15 mmHg higher than WHO/ISH. There is even greater divergence of opinion between the guidelines on the recommended goals of treatment. Using conventional measurement WHO/ISH recommends lowering systolic blood pressure with treatment by 10-20/5-10 mmHg more than JNC VI and BHS depending on whether 'normal' or 'optimal' pressures are to be achieved. Using average daytime ABPM pressure, WHO/ISH recommends lowering the average daytime blood pressure with treatment by 10-30/5-10 mmHg more than JNC VI and BHS depending on whether 'normal' or 'optimal' blood pressures are chosen. These differing recommendations between JNC VI and BHS, and WHO/ISH cannot be reconciled and they are of such magnitude as to carry serious implications for clinical practice, not least among which is that acceptance of the WHO/ISH levels of 'normality' for blood pressure would result in some 45% of the population of all ages and nearly 60% of elderly people being classified as 'hypertensive'.

Topics: Antihypertensive Agents; Blood Pressure Determination; Cardiovascular Agents; Humans; Hypertension; Risk Factors; Societies, Medical; United Kingdom; World Health Organization

To examine discrepancies between co-morbidity of patients included in pre-marketing clinical trials of cardiovascular drugs and patients from daily practice, representing the actual users after marketing, and to investigate the availability of data regarding co-morbidity in registration files.. Data were collected from phase III trials of registration files of 16 drugs, registered in the Netherlands in the period 1985 through 1994 for the indications hypertension, angina pectoris or hypercholesterolemia, and from a general practitioners database. Patients were selected who used drugs from the same therapeutic classes for the same indication as the patients in the pre-marketing trials. Prevalences of concomitant cardiovascular, endocrine and metabolic diseases were compared between pre- and postmarketing populations. Discrepancies were defined as more than 10% difference in prevalences.. Data regarding co-morbidity were present in 13 out of 16 registration files and differed in format of reporting. For all indications, coexisting cardiovascular, endocrine and metabolic diseases were less prevalent in the pre-marketing populations, except ischemic heart disease, which was more prevalent coexisting with angina pectoris and hypercholesterolemia. Discrepancies were found for hypertensive disease, heart failure, diabetes mellitus and myocardial infarction.. Phase III trials testing cardiovascular drugs included patients with concomitant cardiovascular, endocrine and metabolic diseases, but discrepancies were present with patients in daily practice. Development of guidelines for uniform collection and reporting of co-morbidity data in pre-marketing trials is recommended, as well as further utilization of data.

Topics: Angina Pectoris; Cardiovascular Agents; Clinical Trials, Phase III as Topic; Comorbidity; Databases, Factual; Family Practice; Humans; Hypercholesterolemia; Hypertension; Metabolic Diseases; Netherlands; Patient Selection; Pharmacoepidemiology; Prevalence; Registries

To perform an ecological study in an effort to generate questions concerning the preventive impact of various cardiovascular drugs on mortality from stroke and ischaemic heart disease (IHD) in the community, and to explore the association between sales of nitrates and mortality from stroke and IHD.. Out-patient drug utilization (sales) of blood pressure lowering drugs, lipid lowering drugs and nitrates were categorized in four groups of equal size by quartiles and compared with mortality from IHD and stroke, using the group of municipalities with the lowest utilization as reference, from 1989 to 1993 in 283 of Sweden's 288 municipalities, by Poisson regression. Adjustments were made for population size, age and gender proportions, the utilization rate of cardiovascular drugs other than the tested drug group and location of the municipality.. Compared with the group of municipalities with the lowest sales and adjusting only for population size, mortality from IHD and stroke increased with the extent of utilization of blood pressure lowering drugs and nitrates. In contrast, mortality decreased with increased utilization of lipid lowering drugs. After further adjustments by percentage of men, age structure, geographical location (mid-points) of the municipalities, and, as a proxy for cardiovascular disease, the sales of cardiovascular drugs other than the tested drug group, the increased risk associated with blood pressure lowering drugs disappeared, and there was a dose-response association between sales of diuretics and old antihypertensives and decreasing mortality, sales of nitrates continued to be associated with an increased risk, and the low mortality risk associated with sales of lipid lowering drugs persisted.. Lipid lowering drugs may have a preventive impact in the general population, but the preventive impact of blood pressure lowering drugs, with the exception of diuretics and old antihypertensives, may be low in many municipalities. The safety of nitrates needs more investigation at the individual level.

Topics: Antihypertensive Agents; Cardiovascular Agents; Cerebrovascular Disorders; Data Collection; Female; Humans; Hyperlipidemias; Hypertension; Hypolipidemic Agents; Male; Myocardial Ischemia; Nitrates; Sweden

Studies performed in experimental animals and in humans have documented that high blood pressure markedly impairs baroreceptor control of heart rate. Whether a similar impairment also characterizes baroreceptor control of sympathetic activity modulating peripheral vasomotor tone is still unknown. In 28 untreated essential hypertensive subjects [14 of moderate and 14 of more severe degree, age 51.6+/-2.4 and 52.6+/-2.1 years (mean+/-SEM)] and in 13 untreated secondary hypertensives (renovascular or pheochromocytoma, age 50.1+/-4.6 years), we measured beat-to-beat arterial blood pressure (finger photoplethysmographic device), heart rate (electrocardiogram), and efferent postganglionic muscle sympathetic nerve activity (microneurography) at rest and during baroreceptor stimulation and deactivation induced by stepwise intravenous infusions of phenylephrine and nitroprusside, respectively. Data were compared with those obtained in 15 age-matched normotensive control subjects. Muscle sympathetic nerve activity (bursts per 100 heart beats) showed a progressive and significant (P<.01) increase from normotension (40.3+/-3.3) to moderate (55.6+/-4.1) and more severe essential hypertension (68.2+/-4.1), paralleling the progressive increase in blood pressure values. In contrast, muscle sympathetic nerve activity was not increased in secondary hypertensives (40.5+/-6.7) despite blood pressure values similar to or even greater than those of severe essential hypertensives. In both essential and secondary hypertensives, baroreceptor-heart rate control was displaced toward elevated blood pressure values and markedly impaired compared with normotensive subjects (average reduction, 38.5%). In contrast, the sympathoinhibitory and sympathoexcitatory responses to baroreceptor stimulation and deactivation were displaced toward elevated blood pressure values but similar in all groups. Thus, sympathetic activation characterizes essential but not secondary hypertension. Regardless of its nature, however, hypertension is not accompanied by an impairment of baroreceptor modulation of sympathetic activity.

Topics: Blood Pressure; Cardiovascular Agents; Case-Control Studies; Female; Heart Rate; Humans; Hypertension; Hypertension, Renovascular; Male; Middle Aged; Muscle, Skeletal; Nitroprusside; Phenylephrine; Pheochromocytoma; Pressoreceptors; Sympathetic Nervous System

We evaluated ambulatory prescriptions by general practitioners for outpatients with cardiovascular (CV) disease referred to the cardiology outpatient clinic of the Frankfurt University Hospital in order to prove adherence to generally acknowledged therapy standards for treating CV disease.. Appropriateness of current CV medication was assessed according to the following criteria: aspirin or anticoagulants obligatory after myocardial infarction (MI), unless contraindicated; beta-blockers should be prescribed after MI, unless contraindicated or not tolerated; ACE inhibitors should be given in left ventricular dysfunction (LVD) after MI, unless contraindicated; and hypertension should be adequately controlled. 346 patients (28-94 years) received a median of 3 CV drug prescriptions (range 0-7). 240 patients had CAD, 142 patients previous MI, 121 patients had LVD (59 after MI), 143 patients were hypertensive. Aspirin was used appropriately in 80% of all MI patients, 13% received oral anticoagulants due to atrial fibrillation. However, 7% received no antithrombotic therapy. ACE inhibitors were administered in 65% of the MI patients with LVD. beta-blockers were used in 25% of the MI-patients. In the remaining patients, beta-blockers were contraindicated, not tolerated, and/or verapamil had been prescribed. However, in 14% of the patients beta-blockers were withheld without evident reason or alternative drug. In 41% of the hypertensive patients, blood pressure was not sufficiently controlled.. A considerable number of ambulatory prescriptions for CV drugs are not in accordance with current therapeutic guidelines. The role of a cardiology outpatient clinic to detect the misuse or underuse of CV drugs is emphasised.

Topics: Adult; Aged; Aged, 80 and over; Cardiovascular Agents; Coronary Disease; Drug Prescriptions; Drug Utilization; Germany; Humans; Hypertension; Middle Aged; Myocardial Infarction; Outpatient Clinics, Hospital; Prospective Studies

The present study was performed to compare cardioprotective effects of an angiotensin-converting-enzyme inhibitor, imidapril, and of a Ca2+ channel antagonist, amlodipine, against the cardiac hypertrophy in male spontaneously hypertensive rats (SHRs) at the established stage of hypertension. Fifteen-week-old SHRs were given imidapril (2 and 5 mg/kg/day) or amlodipine (10 mg/kg/day) by gavage for 8 weeks. Three hours after the 1st treatment, imidapril moderately reduced blood pressure without changing heart rate, while amlodipine caused a marked reduction in blood pressure accompanied by transient tachycardia. At the end of the treatments, ventricular weight in the imidapril-treated groups was markedly lower, but that in the amlodipine-treated group was only slightly lower than that in the vehicle-treated group. Myocardial collagen content in the imidapril-treated group tended to be decreased, and significant reduction was observed in the low-dose group. In another experiment, the isolated heart of the imidapril-treated animals demonstrated better cardiac compliance than that in the vehicle-treated animals. In contrast, amlodipine failed to improve cardiac function. The present results suggest that imidapril possesses advantageous effects to prevent cardiac hypertrophy and deteriorated cardiac function in SHRs of established stage of hypertension as compared with amlodipine.

Topics: Amlodipine; Angiotensin-Converting Enzyme Inhibitors; Animals; Blood Pressure; Calcium Channel Blockers; Cardiovascular Agents; Collagen; Heart Function Tests; Heart Rate; Hypertension; Imidazoles; Imidazolidines; Male; Myocardium; Organ Size; Rats; Rats, Inbred SHR; Rats, Inbred WKY

An increase in blood pressure, accompanied by atrial fibrillation, agitation, incomprehensible shouts and loss of consciousness, was observed in an elderly, ASA classification group II, cardiovascularly medicated male, 12 min after performance of axillary block with mepivacaine 850 mg containing adrenaline 0.225 mg, for correction of Dupuytren's contracture. After intravenous administration of labetalol, metoprolol and midazolam the patient's condition improved, and 15 min later he woke up. The block was successful and surgery was conducted as scheduled despite persisting atrial fibrillation. Postoperatively, the patient refused DC cardioversion and was treated medically. Both the temporal relationship of events and the response to treatment suggest that a rapid systemic absorption of mepivacaine with adrenaline and/or interaction of these drugs with the patient's cardiovascular medications were responsible for the perioperative complications.

Topics: Absorption; Aged; Akathisia, Drug-Induced; Anesthetics, Local; Anti-Arrhythmia Agents; Antihypertensive Agents; Atrial Fibrillation; Axilla; Cardiovascular Agents; Drug Interactions; Dupuytren Contracture; Epinephrine; Humans; Hypertension; Hypnotics and Sedatives; Intraoperative Complications; Labetalol; Male; Mepivacaine; Metoprolol; Midazolam; Nerve Block; Unconsciousness; Vasoconstrictor Agents

A total of 502 patients presenting in Utsunomiya city and its suburbs during a 10-year period were studied to determine the clinical features of ischemic heart disease and to identify coronary risk factors. The male/female ratio was 1.21, but the ratio decreased with increasing age. The duration of chest pain showed a continuous spectrum between angina and infarction, with a short duration of chest pain not being useful for excluding the diagnosis of myocardial infarction. Hypertension was more common than hypercholesterolemia in this study, although the prevalence of the latter increased slightly with time, along with the shift towards a modernized occupational pattern. Smoking was a more important risk factor for ischemic heart disease in younger individuals than in the elderly, and diabetes mellitus was highly associated with the development of myocardial infarction. The incidence of radiologically diagnosed cardiac hypertrophy and aortic calcification decreased over time. These changes may have resulted in part from improved blood pressure control and the development of new anti-hypertensive and cholesterol-lowering agents.

Topics: Age Factors; Alcohol Drinking; Aortic Diseases; Arteriosclerosis; Calcinosis; Cardiomegaly; Cardiovascular Agents; Chest Pain; Comorbidity; Death, Sudden, Cardiac; Diabetes Mellitus; Female; Humans; Hypercholesterolemia; Hypertension; Japan; Male; Morbidity; Myocardial Ischemia; Occupations; Risk Factors; Smoking; Urban Population

Excess cardiovascular morbidity and mortality among African (black) Americans remains an important yet unexplained public health problem. One possible explanation proposes that intrinsic or acquired abnormalities in coronary vascular reactivity and endothelial function result in excess ischemia among black Americans. To examine this hypothesis, we subjected 80 individuals with normal coronary arteries to invasive testing of coronary artery and microvascular relaxation using intracoronary infusions of acetylcholine and adenosine, a Doppler tipped intracoronary guide wire, and quantitative coronary angiography. We measured the percent increase in coronary blood flow and epicardial diameter after graded infusion of intracoronary acetylcholine and in coronary blood flow after intracoronary adenosine in 31 normotensive subjects (10 black, 21 white) and 49 hypertensive subjects with left ventricular hypertrophy (25 black, 24 white). Categorical and multivariate analyses revealed that in response to intracoronary adenosine and acetylcholine, the depression in endothelium-independent and -dependent microvascular relaxation during peak agonist effect was largely related to the presence of chronic hypertension and left ventricular hypertrophy. Normotensive subjects demonstrated no intrinsic racial differences in conduit and resistance vessel vasoreactivity. In response to maximal infusion of acetylcholine, epicardial coronary arteries constricted similarly in black and white subjects with hypertensive left ventricular hypertrophy and dilated similarly in normotensive black and white subjects. Thus, our study shows that in a cohort of black and white subjects referred for coronary arteriography because of chest pain, African American race is not associated with excess intrinsic or acquired depression in coronary vascular relaxation during the peak effect of the endothelium-dependent and -independent agonists acetylcholine and adenosine, after adjustment for the presence of left ventricular hypertrophy.

Topics: Adenosine; Adult; Black People; Cardiovascular Agents; Cohort Studies; Coronary Circulation; Coronary Vessels; Endothelium, Vascular; Female; Humans; Hypertension; Hypertrophy, Left Ventricular; Infusions, Intra-Arterial; Male; Middle Aged; Muscle Relaxation; Prospective Studies; White People

A series of 7,6- and 7,5-fused bicyclic thiazepinones and oxazepinones were generated and incorporated as conformationally restricted dipeptide surrogates in mercaptoacyl dipeptides. These compounds are potent inhibitors of angiotensin-converting enzyme (ACE) and neutral endopeptidase (NEP) both in vitro and in vivo. Compound 1a, a 7,6-fused bicyclic thiazepinone, demonstrated excellent blood pressure lowering in a variety of animal models characterized by various levels of plasma renin activity and significantly potentiated urinary sodium, ANP, and cGMP excretion in a cynomolgus monkey assay. On the basis of its potency and duration of action, compound 1a (BMS-186716) was advanced into clinical development for the treatment of hypertension and congestive heart failure.

Topics: Angiotensin-Converting Enzyme Inhibitors; Animals; Antihypertensive Agents; Atrial Natriuretic Factor; Cardiovascular Agents; Cyclic GMP; Enzyme Inhibitors; Heart Failure; Hypertension; Macaca fascicularis; Neprilysin; Pyridines; Rats; Renin; Sodium; Thiazepines

To investigate the prevalence of and indications for digoxin use and the prevalence of beta blocker and calcium channel blocker use in older patients with previous myocardial infarction or coronary artery disease (CAD), and the prevalence of use of diuretics, beta blockers, angiotensin-converting enzyme (ACE) inhibitors, and calcium channel blockers in older patients with hypertension in an academic hospital-based geriatrics practice.. A retrospective analysis of charts from 528 unselected older patients, seen from June 1995 through July 1996 at an academic hospital-based geriatrics practice, was performed to investigate the prevalence of digoxin use and indications for digoxin use, the prevalence of beta blocker and calcium channel blocker use in older patients with previous myocardial infarction or coronary artery disease (CAD), and the prevalence of use of diuretics, beta blockers, angiotensin-converting enzyme (ACE) inhibitors, and calcium channel blockers in older patients with hypertension.. An academic hospital-based, primary care geriatrics practice staffed by fellows in a geriatrics training program and full-time faculty geriatricians.. A total of 416 women and 112 men, mean age 81 +/- 8 years (range 58 to 101), were included in the study.. Ninety-two of the 528 patients (17%) were taking digoxin. Recorded indications for digoxin were atrial fibrillation with or without congestive heart failure (CHF) in 39% of patients, CHF with sinus rhythm and abnormal left ventricular ejection fraction (LVEF) in 18% of patients, a clinical assessment of CHF with sinus rhythm and no recorded measurement of LVEF in 20% of patients, paroxysmal atrial fibrillation in 14% of patients, and coronary artery disease (CAD) in 9% of patients. Of 121 patients with previous myocardial infarction, 23 (19%) were prescribed beta blockers, and 54 (45%) were taking calcium channel blockers. Of 173 patients with CAD, 41 (24%) were treated with beta blockers, and 79 (46%) were taking calcium channel blockers. LVEF was not recorded in the charts of 90 of 121 patients (74%) with prior myocardial infarction and of 125 of 173 patients (72%) with CAD. Of 480 older patients with hypertension, 154 (37%) were treated with diuretics, 55 (13%) were treated with beta blockers, 160 (38%) were treated with ACE inhibitors, and 197 (47%) were treated with calcium channel blockers.. In 528 older patients seen in an academic hospital-based geriatrics practice, the prevalence of digoxin use was 19%. Appropriate indications for digoxin were documented clearly in the charts of 53 of 92 patients (57%). Calcium channel blockers were used more often than beta blockers in patients with previous myocardial infarction or CAD. Calcium channel blockers were the most frequently used antihypertensive drugs.

Topics: Academic Medical Centers; Adrenergic beta-Antagonists; Age Factors; Aged; Aged, 80 and over; Ambulatory Care Facilities; Angiotensin-Converting Enzyme Inhibitors; Arrhythmias, Cardiac; Calcium Channel Blockers; Cardiovascular Agents; Coronary Disease; Digoxin; Diuretics; Drug Utilization; Female; Geriatrics; Heart Failure; Humans; Hypertension; Male; Middle Aged; Myocardial Infarction; Retrospective Studies

The peroxidative processes and individual antioxidant protection were measured in patients with different cardiovascular diseases. We concluded that monitoring of this system we were able to detect not only the actual changes of lipid peroxidation and antioxidant defence mechanisms, but additionally the therapeutic efficacy of the treatment.

Topics: Adrenergic beta-Antagonists; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Antioxidants; Cardiovascular Agents; Catalase; Fibrinolytic Agents; Follow-Up Studies; Free Radicals; Glutathione; Glutathione Peroxidase; Humans; Hypertension; Hypolipidemic Agents; Lipid Peroxidation; Malondialdehyde; Myocardial Infarction; Myocardial Ischemia; Nitrates; Reactive Oxygen Species; Superoxide Dismutase; Thrombolytic Therapy; Treatment Outcome

The pathological increase of oxygen free radical generation has already been recognised in more than one hundred diseases. To gain information about the consequences of oxidative stress the investigation of plasma antioxidants seems to be plausible. In our study we used a new kit (RANDOX, England) for measurement of total antioxidant status (TAS) to determine whether it has diagnostic value in comparison with our earlier results of measuring other parameters of oxidative stress in the following diseases: i./In the group of patients with ischemic heart disease (n = 19) the TAS elevated from 1.08 +/- 0.13 to 1.16 +/- 0.11 mM after 2 weeks of cardioprotective drug administration showing the beneficial effect of drug treatment. ii./In the group of patients with essential hypertension (n = 47) its values were below the normal range (1.11 +/- 0.15 mM) at the time of the first investigation and increased gradually following antihypertensive treatment. iii./The changes of TAS values of patients who underwent open (n = 21) or laparoscopic (n = 21) cholecystectomy indicated the less surgical trauma following laparoscopic procedures. Our results suggest that determination of TAS is a valuable and reproducible method to detect the actual antioxidant status in patients.

Topics: Antihypertensive Agents; Antioxidants; Blood; Cardiovascular Agents; Cholecystectomy; Cholecystectomy, Laparoscopic; Humans; Hypertension; Myocardial Ischemia; Oxidative Stress; Reactive Oxygen Species; Reproducibility of Results; Stress, Physiological

Topics: Adult; Arteriosclerosis; Cardiovascular Agents; Female; Humans; Hypertension; Male; Middle Aged; Myocardial Ischemia

The purpose of this study was to assess the blood pressure profile and to measure vasoactive hormones in patients with essential hypertension (n=61), secondary hypertension (n=32) and chronic renal failure (n=32) matched with healthy control subjects (n=35), and to study the relationship between circadian changes in blood pressure and baseline levels of vasoactive hormones and renal function. Non-invasive, automatic blood pressure measurement was performed for 24 or 48 h. Venous plasma concentrations of renin, angiotensin II, aldosterone, arginine vasopressin, atrial natriuretic peptide and endothelin were measured. The mean 24-h blood pressure was higher in all groups of hypertensive patients than in control subjects. The nocturnal blood pressure fall was preserved in essential hypertension, in contrast to secondary hypertension in which it was attenuated. In the patients with chronic renal failure the 24-h mean blood pressure was the same as in the controls. Night-time blood pressure was higher among the chronic renal failure patients than in the control group, and the nightly blood pressure fall in both diastolic and systolic blood pressure was reduced. Plasma concentrations of renin activity, arginine vasopressin, atrial natriuretic peptide, aldosterone and endothelin were significantly increased in secondary hypertension and chronic renal failure, compared to essential hypertension and control subjects. Plasma angiotensin II was increased in chronic renal failure compared to essential hypertension and controls. Estimated creatinine clearance and nightly blood pressure dips were inversely correlated in essential and secondary hypertension, i.e. with a decreasing renal function both systolic and diastolic nightly blood pressure dips were gradually attenuated. In the whole group of patients the nightly systolic and diastolic blood pressure dips were negatively correlated to basal plasma renin activity, plasma aldosterone and atrial natriuretic peptide levels, i.e. the higher the basal plasma hormone level the lower the blood pressure dip. In conclusion, patients with essential hypertension have elevated but normally configured 24-h blood pressure profiles, and patients with different kinds of secondary hypertension have elevated 24-h blood pressure profiles and attenuated nightly systolic and diastolic blood pressure falls. The more the renal function is reduced and the more the plasma levels of renin and aldosterone are increased, the more the nocturna

Topics: Adolescent; Adult; Aged; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Cardiovascular Agents; Case-Control Studies; Circadian Rhythm; Data Interpretation, Statistical; Diastole; Female; Heart Rate; Hormones; Humans; Hypertension; Kidney; Kidney Failure, Chronic; Male; Middle Aged; Systole; Vasodilator Agents; Vasomotor System

Topics: Cardiovascular Agents; Humans; Hypertension; Hypertrophy, Left Ventricular; Ventricular Dysfunction, Left

Aqueous extracts of the leaves of Clusia coclensis, (Guttiferae) injected intravenously to 42 normal Sprague-Dawley rats and to 42 Spontaneous Hypertensive rats, in 7 different doses, induced a rapid and transitory decrease in blood pressure and heart frequency. The magnitude of blood pressure decrease was dose-dependent. The effect was statistically significant (p < or = 0.01), probably due to sympathetic stimuli.

Topics: Animals; Blood Pressure; Cardiovascular Agents; Female; Hypertension; Male; Plant Extracts; Rats; Rats, Inbred SHR; Rats, Sprague-Dawley

A patient with a history of cerebrovascular disease, hypertension, and previous gastrectomy developed metabolic alkalosis and myoclonus. His medications included the anti-hypertensive agents nicardipine hydrochloride, delapril, prazosin; dihydroergotoxin and ticlopidine for cerebral infarction; estazolam for insomnia; azuren-L-glutamine compound and S-M powder. In addition, he had taken 12 grams per day of Ohta's Isan antacid, which contained 625 mg sodium bicarbonate per 1.3 g of antacid powder over a 6-month period. This antacid is commonly used in Japan. This is the first report of a case of metabolic alkalosis and myoclonus secondary to ingestion of a commercially available antacid in Japan.

Topics: Aged; Alkalosis; Antacids; Cardiovascular Agents; Cerebral Infarction; Dyspepsia; Gastrectomy; Humans; Hypertension; Hypnotics and Sedatives; Hypokalemia; Male; Myoclonus; Sleep Initiation and Maintenance Disorders; Sodium Bicarbonate

To describe the use of pharmaceutical medications by patients with diabetes in Sweden.. We analyzed the computerized Surveys of Living Conditions (SLC), performed regularly in Sweden, for the years 1988 and 1989, among individuals aged 16-84 years. Drug use (during a 2-week period) and the use of health services (during a 3-month period) were registered for subjects with diabetes (n = 361) and compared with age- and gender-standardized figures (using the diabetes group as the standard) in subjects with hypertension but without diabetes (n = 980), in subjects with a musculoskeletal condition but without diabetes (n = 2,187), in healthy subjects free from any medical condition (n = 6,664), and in the general population sample (n = 12,717).. The reported use of medication was higher for subjects with diabetes compared with the general population regarding overall use (92.5 vs. 71.9%; P < 0.001), the use of cardiovascular drugs (52.2 vs. 36.3%; P < 0.001), all use of analgesics (43.8 vs. 36.5%; P < 0.05), and use of psychoactive drugs (23.5 vs. 15.3%; P < 0.01). Compared with the hypertension group, the use was lower regarding cardiovascular drugs (52.2 vs. 93.3%; P < 0.001), and compared with the musculoskeletal group, the use was lower regarding all use of analgesics (43.8 vs. 56.5%; P < 0.01) and the use of herbal products (6.8 vs. 11.8%; P < 0.05), but was higher regarding cardiovascular drugs (52.2 vs. 37.8%; P < 0.001). The use was higher compared with the healthy individuals, regarding all groups of drugs with the exception of vitamins and herbal products.. Diabetic subjects have a higher overall use of drugs compared with the general population. Compared with other chronic illnesses, the differences are small except for disease-specific drugs (cardiovascular drugs in the hypertension group and analgesics in the musculoskeletal group). The main difference concerns the comparison with healthy subjects who had a markedly higher drug rate among diabetic subjects, thus signifying a greater impact on health.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Analgesics; Cardiovascular Agents; Diabetes Mellitus; Drug Therapy; Female; Humans; Hypertension; Male; Middle Aged; Musculoskeletal Diseases; Ointments; Phytotherapy; Psychotropic Drugs; Sweden; Vitamins

Certain medications used in cardiovascular therapeutics may contribute to the etiology of substance-induced mood disorders. These medications include digoxin, angiotensin converting enzyme (ACE) inhibitors, beta-blockers, and calcium channel blockers. The objective of this study was to evaluate associations between these drugs and clinical diagnoses of depressive disorders in a population of hospitalized patients.. Two case-control studies were conducted. For each study, subjects were selected from a health records data base maintained at the Calgary General Hospital. Selection of subjects in the first study was restricted to those receiving a discharge diagnosis of congestive heart failure and in the second study to subjects receiving a discharge diagnosis of hypertension. In each of these 2 studies, a single case group was selected along with 2 control groups: a psychiatric control group consisting of subjects receiving a psychiatric diagnosis other than a depressive disorder and a nonpsychiatric control group receiving no psychiatric diagnoses. Drug exposures and other variables were recorded from a chart review.. Exposures to digoxin, beta-blockers, and calcium channel blockers were not associated with depressive diagnoses. An association was observed, however, for ACE inhibitors. An elevated odds ratio (OR) was observed in each case-control study and was stronger in female subjects and subjects over the age of 65.. This is the first reported epidemiological evidence of an association between ACE inhibitors and depressive disorders. The design of this study does not permit a determination of whether the observed association was causal. Additional studies are needed.

Topics: Adult; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Cardiovascular Agents; Cardiovascular Diseases; Case-Control Studies; Depressive Disorder; Female; Heart Failure; Humans; Hypertension; Male; Middle Aged; Odds Ratio; Patient Admission; Risk Factors

The occurrence of apoptosis in heart, kidney and small intestine was investigated in spontaneously hypertensive rats (SHR) treated with doxorubicin (1 mg/kg/week for 6, 9 and 12 weeks) with and without pretreatment with the iron chelator ICRF-187 [(+)1.2-bis(3.5-dioxopiperazinyl-l-yl)propane] (25 mg/kg, i.p., given 30 min before doxorubicin). Animals receiving either ICRF-187 alone or saline were used as controls. Cells undergoing apoptosis were identified ultrastructurally and by staining using the nick-end labeling method. The results obtained by counting cells with positive nick-end labeling showed that, when given in cumulative doses of 9 and 12 (but not 6) mg/kg, doxorubicin induced significant toxicity in the heart, kidneys and intestine in association with apoptosis in epithelial cells of the intestinal mucosa and renal tubules but not in cardiac myocytes. At these doses nick end labeling in the heart was confined to occasional endothelial cells, interstitial dendritic cells and macrophages. The frequency of doxorubicin-induced apoptosis in renal and intestinal epithelial cells was decreased by pretreatment of the SHR with ICRF-187. Our data support the concept that the chronic cardiomyopathy induced by doxorubicin is not mediated by apoptosis of the cardiac myocytes.

Topics: Animals; Apoptosis; Cardiomyopathies; Cardiovascular Agents; Dose-Response Relationship, Drug; Doxorubicin; Heart; Hypertension; Immunohistochemistry; Intestines; Iron Chelating Agents; Kidney; Kidney Diseases; Male; Microscopy, Electron; Myocardium; Rats; Rats, Inbred SHR; Razoxane

Repetitive episodic (18-24 s twice per minute) hypocapnic hypoxia (HH) administered chronically (7 h/day, 35 days) to Sprague-Dawley or Wistar-Kyoto rats results in a sustained increase in daytime blood pressure (BP). We examined acute and chronic BP response to episodic HH and eucapnic hypoxia (EH) in borderline hypertensive rats [first generation (F1) cross between spontaneously hypertensive and Wistar-Kyoto rats]. We hypothesized that episodic HH and EH would create a greater increase in acute and chronic BP in this breed of rat than in previously studied strains. We also examined neural mechanisms by which BP changes from hypoxia are induced. BP and heart rate were examined acutely in nine F1 rats during baseline, HH, EH, EH with prazosin, and EH with prazosin and atropine. Five groups of male F1 rats were studied after 35-day exposure to the following: Unhandled (n = 8): no treatment; Sham (n = 10): episodic compressed air; HH (n = 14): daily episodic hypoxia (2.7%); EH1 (n = 12); hypoxia 2.9%, CO2 8.4%; and EH2 (n = 11): hypoxia 2.8% and CO2 10.5%. Under acute conditions, HH caused a 34.2-mmHg and EH a 77.9-mmHg increase in mean BP. Prazosin partially blocked the increase in BP. Under chronic conditions, HH caused a 10.3-mmHg increase in daytime mean BP, whereas EH caused a fall in mean BP of 16.6 and 9.3 mmHg in the two separately studied groups. In the F1 rat, acute EH causes an elevation of BP but chronic EH causes a fall in BP. The acute response to EH is not predictive of what occurs after chronic exposure in the hypertension-prone F-1 rat.

Topics: Animals; Antihypertensive Agents; Arousal; Atropine; Blood Pressure; Cardiovascular Agents; Heart Rate; Hypertension; Hypocapnia; Hypoxia; Male; Prazosin; Rats; Rats, Inbred WKY; Rats, Sprague-Dawley; Stress, Psychological

Topics: Angiotensin II; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Biphenyl Compounds; Cardiovascular Agents; Heart Failure; Humans; Hypertension; Imidazoles; Losartan; Renin; Tetrazoles

Topics: Aortic Valve Stenosis; Calcium Channel Blockers; Cardiovascular Agents; Coronary Disease; Digitalis Glycosides; Drug Therapy, Combination; Humans; Hypertension

We aimed to examine the association of serum creatinine with health status and current medications in the population of older adults. We employed a cross-sectional study within an ongoing cohort of 3999 residents of three communities of the Established Populations for Epidemiologic Studies of the Elderly who had venepuncture at the 6-year follow-up when they were aged 71 years and older. Serum creatinine levels, history of diabetes and heart attack, current medications, and blood pressure were measured. Creatinine levels were higher in men than in women, and in blacks than in whites. Higher creatinine levels were observed in persons with a history of diabetes or heart attack, and in those reporting use of cimetidine and diuretic medications. Persons taking frusemide and the potassium-sparing diuretics had higher creatinine levels than those taking thiazides. This study confirms associations of higher creatinine with male sex, older age, black race, history of diabetes and cimetidine use reported from cross-sectional research in younger populations and in smaller, more selected groups of older adults. Longitudinal studies will be necessary to strengthen our understanding of the causes of changes in kidney function in the older population.

Topics: Activities of Daily Living; Aged; Aged, 80 and over; Black People; Cardiovascular Agents; Cimetidine; Creatinine; Diabetes Mellitus; Female; Geriatric Assessment; Health Status Indicators; Humans; Hypertension; Male; Myocardial Infarction; Reference Values; White People

The frequency of chronic hypertension among cardiac surgery patients implies that experimental therapies that protect normotensive myocardium will be more clinically relevant if they also protect chronically hypertensive myocardium. We tested the effectiveness of three experimental therapies that protect normotensive myocardium from ischemic injury in both normotensive (NTR) and spontaneously hypertensive (SHR) isolated Sprague-Dawley rat hearts. Post-ischemic recovery of ATP, left ventricular end diastolic pressure, developed pressure, negative and positive left ventricular dP/dt (-dP/dt and +dP/dt) and coronary flow (CF) were compared in ischemically preconditioned, adenosine-pretreated, bethanechol-pretreated and untreated NTR and SHR isolated rat hearts. The effect of time on our preparation was evaluated by comparison to NTR and SHR hearts maintained in vitro for equal duration but not subjected to an ischemic insult (N = 7, all groups). Preconditioning, adenosine and bethanechol significantly improved recovery of ATP, left ventricular end diastolic pressure, developed pressure, -dP/dt, +dP/dt and coronary flow in both NTR and SHR hearts (P < 0.001 vs. untreated, all comparisons). Although recovery was not so pronounced in SHR hearts, these results suggest that experimental therapies that protect normotensive myocardium also protect chronically hypertensive myocardium. The effect of adenosine and that of ischemic preconditioning were nearly identical, and both treatments were significantly more cardioprotective than bethanechol in both NTR and SHR hearts (P < .05 and P < .001, respectively). This result suggests that adenosine buildup is more important than muscarinic receptor stimulation as a mechanism of the protection afforded by ischemic preconditioning.

Topics: Adenosine; Adenosine Triphosphate; Animals; Bethanechol; Cardiovascular Agents; Heart; Hemodynamics; Hypertension; Male; Muscarinic Agonists; Myocardial Ischemia; Myocardium; Rats; Rats, Inbred SHR; Rats, Sprague-Dawley

On the basis of 1501 "Drug Disposal Charts" a comparative analysis was carried out of treatment schemas of ischaemic heart disease and arterial hypertension used by cardiologists and regional general practitioners, taking into account the effectiveness of treatment. Besides that the frequency was analysed of the reports by doctors on adverse reactions occurring during treatment.

Topics: Ambulatory Care Facilities; Cardiac Care Facilities; Cardiovascular Agents; Humans; Hypertension; Myocardial Ischemia; Poland; Treatment Outcome

The effects of the endogenous pressor agents noradrenaline (NA), and angiotensin II (Ang II), and of the hypotensive agents acetylcholine (ACh) and adenosine (ADS), on blood pressure and heart rate in conscious and unrestrained stroke-prone spontaneously hypertensive rats (SHR-SP) and normotensive Wistar Kyoto rats (WKY) of different ages (4-9 weeks old) were investigated. Pressor responses to NA were enhanced in 7- and 9- week-old SHR-SP compared with those in WKY, but pressor responses to Ang II in SHR-SP were not different from those in WKY at all ages. The bradycardias following pressor responses to NA and Ang II were markedly attenuated in SHR-SP, especially older ones. Hypotensive responses to ACH were enhanced in SHR-SP, particularly at 9 weeks of age. However, hypotensive responses to ADS were attenuated in SHR-SP, especially at 7 weeks of age. Transient fall of heart rate due to ADS was also attenuated in 7- and 9- week-old SHR-SP. These alterations of hemodynamic or cardiovascular responses in SHR-SP became more evident in the established stages of hypertension. These results suggest intimate relationships of the enhanced pressor responses to NA, attenuated bradycardias following pressor effects with NA or Ang II, and the attenuated hypotensive responses to ADS with the development or the maintenance of hypertension in SHR-SP.

Topics: Acetylcholine; Adenosine; Age Factors; Angiotensin II; Animals; Blood Pressure; Cardiovascular Agents; Cerebrovascular Disorders; Heart Rate; Hemodynamics; Hypertension; Male; Norepinephrine; Rats; Rats, Inbred SHR; Rats, Inbred WKY

Causes of decompensation of treated chronic congestive heart failure in patients referred for emergency hospitalization were examined prospectively. 111 consecutive patients (76 +/- 11 years) were interviewed and their records examined on admission. The diagnosed underlying diseases were coronary artery disease (80%), hypertensive heart disease (40%), valvular heart disease (11%), and idiopathic dilated (7%) and alcoholic (5%) cardiomyopathy. The grounds for decompensation of chronic congestive heart failure were: insufficient compliance 47% (n = 52, irregular or not intake of medication [25%], salt [9%] or fluid [7%] excess, stopping medication because of side effects [6%]), uncontrolled hypertension (27%), insufficient diuretic therapy in spite of progressive symptoms (23%), treatment with negative inotropic drugs (21%), acute rhythm disturbances (14%), acute myocardial infarction or unstable angina pectoris (14%), infections (6%). 80% of the patients were treated with diuretics, 34% with digoxin, 31% with ACE-inhibitors. Insufficient basic knowledge about the disease (regular weighing, diet, behavior if symptoms worsen) was found in 78% of patients, complete lack of knowledge concerning the prescribed drugs in 29%. Only 44% were regularly followed by their physicians, 53% had either no regular follow-ups or they were set at too long intervals.. In the majority of patients, one or more avoidable causes leading to decompensation of chronic congestive heart failure can be identified. The main potential for intervention aiming at a reduction of the hospitalization frequency lies in improving patient compliance and state of the art medication by the primary care physician. Equally unsatisfactory is the low frequency of follow-up checks to reassess and renew drug therapy.

Topics: Aged; Cardiovascular Agents; Coronary Disease; Diet; Drug Prescriptions; Female; Heart Failure; Hospitalization; Humans; Hypertension; Male; Middle Aged; Patient Compliance; Patient Education as Topic; Prospective Studies; Sick Role

Any treatment used in pregnant women must take into account the effects of the substance in question of the fetus and the particular sensitivity of the latter during the first three months of development. The majority of drugs used in cardiology can be prescribed during pregnancy: digitalis preparations, furosemide, certain beta-blockers, verapamil, nifedipine (except during the first three months), quinidine, disopyramide, lignocaine, flecainide, amiodarone, heparins (non-fragmented and low molecular weight), central antihypertensive agents, dipyridamole and aspirin. In contrast, some drugs should be avoided because of insufficient information regarding their maternal and fetal consequences (bumetamide, modamide, the most recent beta-blockers, cibenzoline, ticlopidine) or because of harmful adverse effects on the fetus (spironolactones, bipyridines, diltiazem) or the newborn infant (angiotensin converting enzyme inhibitors). Finally, with certain medications (propafenone, oral anticoagulants), it is important to be able to compare maternal risks due to the disease and fetal risks induced by the drug. Modification of the conditions of use of these drugs and very careful monitoring of the patient most often suffice to avoid untoward events or complications with potentially serious medicolegal consequences and which may implicate the liability of the prescriber.

Topics: Anticoagulants; Cardiovascular Agents; Female; Humans; Hypertension; Pregnancy; Pregnancy Complications, Cardiovascular; Risk Factors

In choosing drugs for treatment of ischemic heart disease or hypertension one has--next to effects on angina or blood pressure--to consider possible influences on long term course. A simple dosing-scheme with a low number of tablets as well as a thorough information of the patient about the prescribed medication are equally important for the therapeutic success.

Topics: Adrenergic beta-Antagonists; Calcium Channel Blockers; Cardiovascular Agents; Coronary Disease; Drug Tolerance; Humans; Hypertension

1. The angiotensin II type 1 receptor antagonist, losartan, prevented the development of hypertension in spontaneously hypertensive rats (SHR). 2. Losartan also prevented the development of left ventricular hypertrophy and vascular amplifier abnormalities. 3. Part of the hypotensive effect induced by long-term treatment with losartan persisted for a long time after the withdrawal of treatment. 4. The results support the hypothesis that angiotensin II contributes to the development of hypertension and cardiovascular hypertrophy in SHR.

Topics: Angiotensin II; Angiotensin Receptor Antagonists; Animals; Biphenyl Compounds; Blood Pressure; Cardiomegaly; Cardiovascular Agents; Cardiovascular Physiological Phenomena; Cardiovascular System; Hindlimb; Hypertension; Imidazoles; Losartan; Male; Rats; Rats, Inbred SHR; Rats, Inbred WKY; Tetrazoles; Time Factors

Topics: Adult; Aged; Blood Flow Velocity; Cardiovascular Agents; Carotid Arteries; Coronary Disease; Hemodynamics; Humans; Hypertension; Lung Diseases, Obstructive; Male; Middle Aged; Pacemaker, Artificial; Pulse

It has been demonstrated that audiogenic stress (AS) can induce elevation of arterial blood pressure (ABP) in animals and humans and that noise-induced hearing loss may be associated with alterations in Mg metabolism. Experiments were designed to determine whether 1) there is a causal relationship among environmental noise stress, serum and vascular tissue (aortas and portal veins) Mg contents, and development of hypertension and 2) such noise-induced hypertension has a microcirculatory basis and what the mechanism may be. Rats maintained on normal Mg-containing diets for 12 wk (plasma [Mg] = 0.96 +/- 0.02 mM) and subjected to AS (85 dB(A), 12 h/day for 8 wk; 95 dB(A), 16 h/day for 4 wk) demonstrated significant elevation in systolic and diastolic ABP; plasma [Mg] showed a 15% deficit, whereas aortic and portal vein muscle exhibited slight reductions in Mg content and elevation in Ca. Moderate and more severely Mg-deficient animals not subjected to AS also exhibited significant elevations in systolic and diastolic ABP; vascular tissue Mg content decreased, whereas Ca content rose. Animals subjected to combined Mg deficiency and AS for 12 wk exhibited the greatest deficits in plasma and vascular muscle Mg and the greatest elevations in systolic and diastolic ABP; vascular tissue Ca contents also showed the greatest increases. In situ measurements of mesenteric arterioles, venules, and precapillary sphincters in the various subgroups revealed that the lower the plasma [Mg], the more constricted the microvessels, and the higher the ABP, the lower the plasma [Mg]. Capillary blood flow velocities were decreased in relation to the degree of plasma Mg deficit.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Calcium; Cardiovascular Agents; Diet; Hypertension; Magnesium; Magnesium Deficiency; Male; Microcirculation; Muscle, Smooth, Vascular; Noise; Rats; Rats, Inbred Strains; Stress, Physiological

Topics: Adult; Cardiovascular Agents; Coronary Artery Bypass; Coronary Disease; Humans; Hypertension; Male; Middle Aged; Prognosis

Topics: Antihypertensive Agents; Calcium Channel Blockers; Cardiac Glycosides; Cardiomyopathy, Dilated; Cardiovascular Agents; Coronary Disease; Diuretics; Drug Evaluation; Drug Therapy, Combination; Humans; Hypertension; Nitrates; Vasodilator Agents

The structure of consumption and need in cardiovascular drugs were studied in a hospital and in the Kirghiz Scientific Research Institute of Cardiology according to a scheme developed in the USSR Cardiology Research Center. Use of cardiovascular drugs was studied with respect to optimal results of therapy in 361 patients with main cardiac pathology (ischemic heart disease, essential hypertension and their combination) who had received 1125 courses of drug treatment. The prescriptions were analysed according to their intensity, regularity and optimal effect. The authors assessed provision of cardiological patients of Frunze with drugs and gave recommendations on its improvement, in particular, satisfaction of need in some active drugs (prolonged nitrates, calcium antagonists, cardiac glycosides).

Topics: Cardiovascular Agents; Coronary Disease; Drug Utilization; Humans; Hypertension; Kyrgyzstan; Urban Population

Topics: Angina Pectoris; Cardiovascular Agents; Coronary Disease; Heart Failure; Humans; Hypertension

Topics: Acebutolol; Adult; Aged; Cardiovascular Agents; Coronary Disease; Delayed-Action Preparations; Drug Evaluation; Female; Flavonoids; Hemodynamics; Humans; Hypertension; Isosorbide Dinitrate; Male; Middle Aged; Phenethylamines; Tablets; Time Factors

The responsiveness to vasoactive agents in the perfused hindlimb of DOCA-salt hypertensive rats was examined and compared with that of normotensive rats. The vasoconstrictor responses in the femoral vascular bed to norepinephrine and serotonin were markedly potentiated in DOCA-salt hypertensive rats as compared with those in normotensive rats, and no change was found in the responses to angiotensin II. On the other hand, the vasodilatory response in DOCA-salt hypertensive rats to isoproterenol was attenuated without any marked changes in responsiveness to acetylcholine, nitroprusside and papaverine. These results suggested that the reduced vasodilator responses as well as the increased vasoconstrictor responses occur to some specific vasoactive agents in DOCA-salt hypertensive rats.

Topics: Angiotensin II; Animals; Cardiovascular Agents; Desoxycorticosterone; Dose-Response Relationship, Drug; Hindlimb; Hypertension; Male; Norepinephrine; Rats; Rats, Inbred Strains; Regional Blood Flow; Serotonin; Vasoconstrictor Agents; Vasodilator Agents

Construction and chronic implantation of fluid-filled arterial and ventricular catheters and renal artery constrictors for testing hemodynamic drug effects in conscious dogs are described. The two catheters were made from commercially available silicone rubber and Tygon tubing connected by a molded silicone rubber plate. The blood pressure catheter was inserted via the superficial iliac artery into the abdominal aorta; and the left ventricular catheter, through the apex of the heart. Application of silicone rubber constrictors to both renal arteries resulted in the following hemodynamic values: BPs 180 +/- 4 mm Hg; BPd 111 +/- 2 mm Hg; LVPdp/dt max 3250 +/- 122 mm Hg/sec; and HR 82 +/- 4 beats/sec. Simultaneous recording of LVP and dp/dt signals with Millar Micro-Tip and fluid-filled catheters revealed a difference in signal form and size. Damping the LVP signal of the fluid-filled catheter either with a low-pass filter of 10-30 Hz or using 2-3% dextran solution as catheter fluid abolished this difference. However, a time lag and a difference in dynamic response to positive inotropic agents were still present. Based on our findings, fluid-filled ventricular catheters are recommended for routine work. The effects of antihypertensive, antianginal, and cardiotonic reference compounds could be easily detected with this methodology.

Topics: Animals; Cardiac Catheterization; Cardiovascular Agents; Catheterization; Constriction; Dogs; Drug Evaluation, Preclinical; Female; Hemodynamics; Hypertension; Male; Renal Artery

Topics: Adrenergic beta-Antagonists; Ambulatory Care; Antihypertensive Agents; Calcium Channel Blockers; Cardiovascular Agents; Coronary Disease; Death, Sudden; Diuretics; Humans; Hypertension; Myocardial Infarction

Topics: Aged; Amyloidosis; Antihypertensive Agents; Arrhythmias, Cardiac; Body Weight; Cardiac Glycosides; Cardiovascular Agents; Cardiovascular Diseases; Cardiovascular System; Coronary Circulation; Coronary Disease; Heart Valve Diseases; Hemodynamics; Humans; Hypertension; Myocardial Contraction; Organ Size

Topics: Angina Pectoris; Anti-Arrhythmia Agents; Antihypertensive Agents; Arrhythmias, Cardiac; Cardiotonic Agents; Cardiovascular Agents; Cardiovascular Diseases; Fibrinolytic Agents; Hemodynamics; Humans; Hypertension; Platelet Aggregation; Thrombosis

Topics: Cardiac Surgical Procedures; Cardiovascular Agents; Cardiovascular Diseases; Coronary Disease; Echocardiography; Heart Failure; Humans; Hypertension; Kidney Failure, Chronic; Pericarditis; Renal Dialysis

The cardiovascular actions of the dopaminergic ergoline, pergolide were examined in pentobarbital-anesthetized dogs. When administered intravenously (i.v.) to dogs made hypertensive by sino-aortic deafferentation, pergolide produced a sustained reduction in blood pressure, dilatation of the hindlimb vasculature and bradycardia. The antihypertensive action of pergolide in neurogenic hypertensive dogs was converted into a pressor action when it was given to dogs pretreated with i.v. sulpiride or hexamethonium plus atropine. Pergolide caused significant impairment of renal vasoconstriction elicited during stimulation of renal sympathetic nerves but not that caused by exogenous norepinephrine. The inhibitory action of pergolide on renal sympathetic nerve function was antagonized by sulpiride suggesting that pergolide activated presynaptic dopamine receptors. Direct administration of pergolide within the central nervous system via the cisterna magna (i.c.) to normotensive dogs also resulted in hypotension, bradycardia and iliac vasodilatation. The central actions of pergolide were prevented by sulpiride (i.c.) but not by yohimbine (i.c.), which indicates that specific activation of central dopamine receptors was responsible for these actions of pergolide. The antihypertensive, bradycardic and iliac vasodilatory actions of i.v. pergolide in neurogenic hypertensive dogs were significantly attenuated by i.c. sulpiride. It was determined that while this dose of sulpiride antagonized central dopamine receptors, it did not antagonize peripheral presynaptic dopamine receptors. These results suggest that pergolide exerts antihypertensive and bradycardic actions via simultaneous stimulation of dopamine receptors in the brain and on postganglionic sympathetic neurons. While presynaptic dopamine receptor activation contributes to the blood pressure lowering action of pergolide, stimulation of central dopamine receptors appears to be the dominant mechanism by which pergolide elicits the observed antihypertensive and bradycardic effects. Pergolide appears to lower blood pressure by a novel mechanism of action and may offer an additional therapeutic approach for the treatment of hypertension.

Topics: Animals; Blood Pressure; Cardiovascular Agents; Cardiovascular System; Central Nervous System; Dogs; Ergolines; Female; Heart Rate; Hypertension; Male; Norepinephrine; Pergolide; Peripheral Nerves; Receptors, Dopamine; Renal Circulation; Sulpiride; Vascular Resistance

This case is typical of cardiovascular drug regimens in the elderly. Indeed, patients are often on several additional drugs for cardiovascular problems as well as other diseases. Familiarity with the pharmacology of all drugs is mandatory. Interactions of drugs can be complex, and a clinical pharmacologist can be a helpful resource. The classic interaction in cardiovascular drug regimens, as in this case, is with the combination of digoxin and potassium-depleting diuretics. The special interactions of cardiovascular and psychotropic drugs will be discussed elsewhere in this symposium. General clinical concerns in the care of patients taking cardiovascular drugs include scrutiny of drug choice, dosage, and combination. The dosage of drugs may need to be altered as the client ages. Drug types and combinations also may need to be changed to meet the needs of the patient's altered physiologic responses. The patient's response to drug therapy must be continuously evaluated. The best rule is to ensure that the patient takes the least number of drugs at the minimum dose required for desired effects. Starting drug dosages low and increasing them gradually often prevent toxicity. The nurse's assessment of subtle behavior or physical changes is important for the early detection of toxicity and adverse reactions. The possibility that a noted change is drug precipitated should always be considered. Health education of the client, family, or appropriate others is a significant nursing contribution to care. Awareness of drug side effects and specific offsetting interventions can prevent many discomforts and complications. Often making the patient aware of his changing body needs helps to elicit cooperation.

Topics: Aged; Aging; Arrhythmias, Cardiac; Cardiovascular Agents; Coronary Disease; Female; Heart Failure; Humans; Hypertension; Kinetics; Middle Aged

Topics: Cardiovascular Agents; Cardiovascular Diseases; Diet, Sodium-Restricted; Humans; Hypertension; Patient Education as Topic; Pharmacology, Clinical; United States; United States Food and Drug Administration

Topics: Angiotensin II; Animals; Captopril; Cardiovascular Agents; Clonidine; Dose-Response Relationship, Drug; Drug Tolerance; Hydrochlorothiazide; Hypertension; Indomethacin; Male; Methyltyrosines; Prazosin; Propranolol; Quinazolines; Rats; Renin

Topics: Adult; Cardiovascular Agents; Coronary Disease; Hemostasis; Humans; Hypertension; Magnetics; Middle Aged

Drug usage was studied in a geriatric hypertension-screening program. A questionnaire was used to collect the required information from patients visiting the clinic during three successive years. The study included 1,711 patients, of whom 76.6 percent were regularly using a drug preparation. A consistent increase was noted in the average number of drug categories used with increasing age, from 1.6 in patients under 70 to 2.6 in patients over 84 years old. The most common drug categories involved were antihypertensive agents, cardiovascular drugs, vitamins, and internal analgesics.

Topics: Aged; Analgesics; Antihypertensive Agents; Cardiovascular Agents; Drug Utilization; Female; Humans; Hypertension; Male; Mass Screening; Surveys and Questionnaires; Vitamins

Topics: Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Cardiovascular Agents; Diuretics; Female; Humans; Hypertension; Male; Middle Aged; Rheumatic Heart Disease

Topics: Cardiovascular Agents; Dihydroergotoxine; Drug Therapy; Ergot Alkaloids; Geriatrics; Hypertension; Intracranial Arteriosclerosis; Tuberous Sclerosis

Topics: Cardiovascular Agents; Cats; Cheese; Chlorpromazine; Dihydroergotoxine; Ergot Alkaloids; Hypertension; Iproniazid; Monoamine Oxidase Inhibitors; Oxidoreductases; Pharmacology; Phenelzine; Rats; Research; Toxicology; Tranylcypromine; Tyramine

Topics: Cardiovascular Agents; Ergonovine; Ergot Alkaloids; Hypertension; Oxytocics; Vasoconstrictor Agents

Topics: Antihypertensive Agents; Asthma; Cardiovascular Agents; Colitis; Hypertension; Muscle Relaxants, Central; Parasympatholytics; Vasodilator Agents

Topics: Cardiovascular Agents; Hydrochlorothiazide; Hypertension; Reserpine

Topics: Adrenal Cortex Hormones; Angiotensin II; Animals; Cardiovascular Agents; Catecholamines; Desoxycorticosterone; Dogs; Epinephrine; Heart; Hypertension; Norepinephrine

Topics: Cardiovascular Agents; Double-Blind Method; Ergot Alkaloids; Essential Hypertension; Hypertension

Topics: Autonomic Agents; Cardiovascular Agents; Hypertension; Mecamylamine; Muscle Relaxants, Central; Pentolinium Tartrate

Topics: Antihypertensive Agents; Blood Pressure; Blood Pressure Determination; Cardiovascular Agents; Humans; Hypertension; Muscle Relaxants, Central; Pentolinium Tartrate

Topics: Acetazolamide; Antihypertensive Agents; Cardiovascular Agents; Chlorothiazide; Hypertension; Muscle Relaxants, Central; Reserpine

Topics: Aged; Antihypertensive Agents; Cardiovascular Agents; Ergot Alkaloids; Humans; Hypertension; Muscle Relaxants, Central; Secologanin Tryptamine Alkaloids; Veratrum Alkaloids

Topics: Adrenal Cortex; Adrenal Cortex Diseases; Adrenal Cortex Hormones; Cardiovascular Agents; Humans; Hydroxylation; Hypertension; Male

Topics: Aged; Aged, 80 and over; Cardiovascular Agents; Cardiovascular System; Electrocardiography; Ergoloid Mesylates; Ergot Alkaloids; Humans; Hypertension

Topics: Blood Pressure; Blood Pressure Determination; Cardiovascular Agents; Ergot Alkaloids; Hypertension; Pressure

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Hypertension; Oxytocics

Topics: Ambulatory Care Facilities; Cardiovascular Agents; Double-Blind Method; Ergot Alkaloids; Hypertension; Outpatients; Oxytocics

Topics: Cardiovascular Agents; Cholesterol; Hypertension; Monitoring, Physiologic; Muscle Relaxants, Central; Pentolinium Tartrate

Topics: Cardiovascular Agents; Dermatologic Agents; Hydralazine; Hypertension; Muscle Relaxants, Central; Pentolinium Tartrate; Reserpine

Topics: Cardiovascular Agents; Hydralazine; Hypertension; Hypertension, Malignant; Muscle Relaxants, Central; Reserpine

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Parasympatholytics

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Reserpine; Stress, Psychological

Topics: Antihypertensive Agents; Cardiovascular Agents; Essential Hypertension; Hypertension; Muscle Relaxants, Central; Secologanin Tryptamine Alkaloids

Topics: Asthma; Cardiovascular Agents; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Pentolinium Tartrate

Topics: Cardiovascular Agents; Cardiovascular Diseases; Ergoloid Mesylates; Ergot Alkaloids; Hypertension; Oxytocics

Topics: Cardiovascular Agents; Combined Modality Therapy; Hypertension; Muscle Relaxants, Central; Reserpine

Topics: Aged; Antihypertensive Agents; Cardiovascular Agents; Combined Modality Therapy; Humans; Hypertension; Muscle Relaxants, Central; Secologanin Tryptamine Alkaloids

Topics: Cardiovascular Agents; Humans; Hypertension; Muscle Relaxants, Central; Pentolinium Tartrate

Topics: Cardiovascular Agents; Claviceps; Ergonovine; Ergot Alkaloids; Hypertension; Secale

Topics: Ambulatory Care Facilities; Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Pentolinium Tartrate

Topics: Cardiovascular Agents; Hypertension; Meprobamate; Muscle Relaxants, Central; Pentolinium Tartrate

Topics: Cardiovascular Agents; Humans; Hypertension; Muscle Relaxants, Central; Tartrates

Topics: Cardiovascular Agents; Enzyme Therapy; Ergoloid Mesylates; Ergot Alkaloids; Humans; Hypertension; Reserpine

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hydralazine; Hypertension; Muscle Relaxants, Central; Neostigmine; Reserpine

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Ganglionic Blockers; Hexamethonium Compounds; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Pentolinium Tartrate

Topics: Autonomic Agents; Cardiovascular Agents; Chlorisondamine; Hypertension; Muscle Relaxants, Central

Topics: Aged; Antihypertensive Agents; Brain Ischemia; Cardiovascular Agents; Disease; Hypertension; Muscle Relaxants, Central; Secologanin Tryptamine Alkaloids; Sympatholytics

Topics: Blood Circulation; Cardiovascular Agents; Hexamethonium; Humans; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Ganglionic Blockers; Hypertension; Muscle Relaxants, Central; Pentolinium Tartrate

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Pentolinium Tartrate

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Pentolinium Tartrate

Topics: Aged; Cardiovascular Agents; Disease; Ergot Alkaloids; Humans; Hypertension; Oxytocics

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Pentolinium Tartrate

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central

Topics: Autonomic Nervous System Diseases; Cardiovascular Agents; Dihydroergotoxine; Ergoloid Mesylates; Ergot Alkaloids; Hypertension; Oxytocics

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Essential Hypertension; Hypertension; Oxytocics

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Pentolinium Tartrate

Topics: Camphor; Cardiovascular Agents; Hypertension; Mecamylamine; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Cardiovascular System; Humans; Hypertension; Muscle Relaxants, Central; Pentolinium Tartrate

Topics: Bis-Trimethylammonium Compounds; Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Reserpine

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Hydralazine; Hypertension; Hypnotics and Sedatives; Muscle Relaxants, Central; Rauwolfia; Reserpine; Sympatholytics

Topics: Cardiovascular Agents; Hypertension; Hypnotics and Sedatives; Muscle Relaxants, Central; Rauwolfia; Reserpine; Veratrum Alkaloids

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Pentolinium Tartrate

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Heart Failure; Hypertension; Muscle Relaxants, Central; Vascular Diseases

Topics: Cardiovascular Agents; Hypertension; Hypertension, Malignant; Muscle Relaxants, Central; Pentolinium Tartrate

Topics: Cardiovascular Agents; Hexamethonium; Hydralazine; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Cardiovascular Agents; Ergot Alkaloids; Hypertension; Hypotension

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Hypertension; Pregnancy; Pregnancy Complications

Topics: Cardiovascular Agents; Hematuria; Hexamethonium; Hypertension; Muscle Relaxants, Central; Pentolinium Tartrate

Topics: Antihypertensive Agents; Cardiovascular Agents; Hexamethonium; Hypertension; Hypnotics and Sedatives; Muscle Relaxants, Central; Pentolinium Tartrate; Rauwolfia; Secologanin Tryptamine Alkaloids

Topics: Cardiovascular Agents; Disease Management; Ganglionic Blockers; Hypertension; Muscle Relaxants, Central

Topics: Antihypertensive Agents; Cardiovascular Agents; Chlorides; Hexamethonium; Hypertension; Muscle Relaxants, Central; Reserpine; Secologanin Tryptamine Alkaloids

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Arterial Pressure; Blood Pressure; Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Hypertension; Oxytocics

Topics: Cardiovascular Agents; Ergot Alkaloids; Hypertension; Oxytocics

Topics: Cardiovascular Agents; Hydralazine; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Antihypertensive Agents; Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Rauwolfia; Secologanin Tryptamine Alkaloids

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Peripheral Arterial Disease; Salts; Thromboangiitis Obliterans

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Lung; Muscle Relaxants, Central

Topics: Antihypertensive Agents; Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Hypertension; Oxytocics

Topics: Cardiovascular Agents; Hexamethonium Compounds; Hypertension; Muscle Relaxants, Central

Topics: Antihypertensive Agents; Cardiovascular Agents; Hexamethonium; Hydralazine; Hypertension; Muscle Relaxants, Central; Rauwolfia; Secologanin Tryptamine Alkaloids; Sympatholytics

Topics: Antihypertensive Agents; Cardiovascular Agents; Drug Therapy, Combination; Hypertension; Muscle Relaxants, Central; Secologanin Tryptamine Alkaloids; Sympatholytics; Veratrum Alkaloids

Topics: Cardiovascular Agents; Hypertension; Hypertension, Malignant; Muscle Relaxants, Central

Topics: Antihypertensive Agents; Cardiovascular Agents; Hypertension; Reserpine; Secologanin Tryptamine Alkaloids

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central

Topics: Blood Circulation; Cardiovascular Agents; Hypertension; Hypotension; Muscle Relaxants, Central; Sympatholytics; Veratrum Alkaloids

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Cyclopentanes; Hypertension; Muscle Relaxants, Central; Salts

Topics: Cardiovascular Agents; Hydralazine; Hypertension; Muscle Relaxants, Central; Pentolinium Tartrate; Sympatholytics

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Antihypertensive Agents; Cardiovascular Agents; Depression; Depressive Disorder; Hypertension; Muscle Relaxants, Central; Secologanin Tryptamine Alkaloids

Topics: Alkaloids; Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central; Salts; Veratrum; Veratrum Alkaloids

Topics: Antihypertensive Agents; Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Secologanin Tryptamine Alkaloids; Sympatholytics

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Dihydroergotoxine; Ergoloid Mesylates; Ergot Alkaloids; Hypertension

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Lung; Muscle Relaxants, Central

Twenty-one patients have been treated for hypertension with oral doses of hexamethonium salts, Apresoline(R) or combinations of both. Three of 18 patients had good or excellent response to hexamethonium alone. Five of 13 treated with hexamethonium salts plus Apresoline had good or excellent results, as did 8 of 14 treated with Apresoline alone. The addition of very small doses of hexamethonium chloride to optimal doses of Apresoline improved the effect of the Apresoline in three patients. Postural hypotension and constipation due to hexamethonium were the most serious undesirable effects.

Topics: Cardiovascular Agents; Constipation; Hexamethonium; Hydralazine; Hypertension; Hypotension, Orthostatic; Muscle Relaxants, Central; Salts; Sympatholytics

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Administration, Sublingual; Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Hypertension; Oxytocics

Topics: Cardiovascular Agents; Hypertension; Hypertension, Malignant; Muscle Relaxants, Central

Hexamethonium is a potent anti-hypertensive agent. Its use is associated with prominent and unpleasant side effects, and sometimes with circulatory complications from excessive depressor action. It is suitable for relatively few hypertensive patients, and often fails when renal insufficiency is present. The degree of care required to obtain satisfactory effectiveness is such that the program of treatment becomes too unwieldy for general use.

Topics: Antihypertensive Agents; Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Administration, Oral; Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Autonomic Agents; Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Pyrroles

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central; Salts

Topics: Anesthesia; Barbiturates; Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Secobarbital

Topics: Blood Pressure; Cardiovascular Agents; Hexamethonium; Humans; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Cardiovascular Agents; Cardiovascular System; Ergot Alkaloids; Hypertension; Oxytocics

Topics: Blood Circulation; Body Temperature; Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Bis-Trimethylammonium Compounds; Cardiovascular Agents; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Humans; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Hypertension

Topics: Cardiovascular Agents; Hypertension; Hypertension, Malignant; Muscle Relaxants, Central; Rauwolfia

Topics: Adrenergic Antagonists; Cardiovascular Agents; Hypertension; Imidazolines; Muscle Relaxants, Central; Sympatholytics

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Hydralazine; Hypertension; Hyperthermia, Induced; Muscle Relaxants, Central; Sympatholytics

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Ergot Alkaloids; Hypertension; Oxytocics; Secale

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Essential Hypertension; Hypertension; Oxytocics

Topics: Cardiovascular Agents; Ergot Alkaloids; Hypertension; Oxytocics

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Bis-Trimethylammonium Compounds; Cardiovascular Agents; Hypertension; Muscle Relaxants, Central

Topics: Antihypertensive Agents; Cardiovascular Agents; Ergot Alkaloids; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Blood; Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Sympatholytics; Urine

Topics: Cardiovascular Agents; Diet; Dietetics; Electrocardiography; Ergot Alkaloids; Hypertension

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Salts

Topics: Cardiovascular Agents; Endocrine System Diseases; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Ergot Alkaloids; Eye; Fundus Oculi; Hypertension

Topics: Cardiovascular Agents; Hexamethonium; Humans; Hypertension; Hypnotics and Sedatives; Muscle Relaxants, Central; Rauwolfia; Secologanin Tryptamine Alkaloids

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central

Topics: Blood Pressure; Cardiovascular Agents; Hexamethonium; Hypertension; Hypotension; Muscle Relaxants, Central; Salts

Topics: Cardiovascular Agents; Humans; Hypertension; Hypertension, Pulmonary; Mitral Valve Stenosis; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Epistaxis; Hexamethonium; Hypertension; Muscle Relaxants, Central; Shock

Topics: Administration, Oral; Cardiovascular Agents; Humans; Hypertension; Muscle Relaxants, Central; Salts

Topics: Cardiovascular Agents; Hexamethonium; Humans; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Hydralazine; Hypertension; Hypertension, Malignant; Muscle Relaxants, Central; Sympatholytics

Topics: Cardiovascular Agents; Ergot Alkaloids; Hypertension

Topics: Cardiovascular Agents; Ergot Alkaloids; Eye; Female; Fundus Oculi; Humans; Hypertension; Uterus

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Ballistocardiography; Cardiovascular Agents; Electrocardiography; Hexamethonium; Humans; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hydralazine; Hypertension; Hypnotics and Sedatives; Muscle Relaxants, Central; Pentolinium Tartrate; Rauwolfia; Sympatholytics

Topics: Antihypertensive Agents; Cardiovascular Agents; Ergot Alkaloids; Hypertension; Oxytocics; Secologanin Tryptamine Alkaloids; Sympatholytics

Topics: Cardiovascular Agents; Hexamethonium; Hydralazine; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Cardiovascular Agents; Essential Hypertension; Female; Hexamethonium Compounds; Hypertension; Muscle Relaxants, Central; Pre-Eclampsia; Pregnancy; Pregnancy Complications

Topics: Cardiovascular Agents; Heart Failure; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Bis-Trimethylammonium Compounds; Cardiovascular Agents; Electrocardiography; Humans; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Hydralazine; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Amobarbital; Ballistocardiography; Barbiturates; Cardiovascular Agents; Hexamethonium; Hydralazine; Hypertension; Muscle Relaxants, Central; Phentolamine; Sympatholytics; Veratrum Alkaloids

Topics: Bis-Trimethylammonium Compounds; Cardiovascular Agents; Cyclopentanes; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Hydralazine; Hypertension; Muscle Relaxants, Central; Phenoxybenzamine; Sympatholytics; Veratrum; Veratrum Alkaloids

Topics: Cardiovascular Agents; Hydralazine; Hypertension; Muscle Relaxants, Central; Salts; Sympatholytics

Topics: Cardiovascular Agents; Ergot Alkaloids; Humans; Hypertension; Oxytocics

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Disease Management; Ferrocyanides; Hypertension; Muscle Relaxants, Central; Sympatholytics; Thiocyanates

Topics: Cardiovascular Agents; Essential Hypertension; Hexamethonium; Hydralazine; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Antihypertensive Agents; Cardiovascular Agents; Dihydroergotoxine; Ergoloid Mesylates; Ergot Alkaloids; Hypertension; Oxytocics

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Humans; Hydralazine; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Cardiovascular Agents; Death; Hexamethonium; Hydralazine; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Hypertension

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Chlorides; Hydralazine; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Cardiovascular Agents; Humans; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Hypertension; Oxytocics

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Autonomic Agents; Cardiovascular Agents; Ergot Alkaloids; Humans; Hypertension; Muscle Relaxants, Central; Sympatholytics; Thiocyanates; Veratrum Alkaloids

Topics: Cardiovascular Agents; Hexamethonium; Hydralazine; Hypertension; Hypotension; Muscle Relaxants, Central; Phenoxybenzamine; Salts; Sympatholytics; Tetraethylammonium

Topics: Bis-Trimethylammonium Compounds; Cardiovascular Agents; Hexamethonium; Hydralazine; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Cardiovascular Agents; Hexamethonium; Hydralazine; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Blood Pressure; Cardiovascular Agents; Humans; Humerus; Hypertension; Muscle Relaxants, Central

Topics: Autonomic Nervous System Diseases; Blood Pressure; Cardiovascular Agents; Dihydroergotoxine; Ergot Alkaloids; Hypertension; Oxytocics

Topics: Bis-Trimethylammonium Compounds; Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Pregnancy; Pregnancy Complications

Topics: Cardiovascular Agents; Hexamethonium; Hydralazine; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Essential Hypertension; Hypertension; Oxytocics

Topics: Aged; Cardiovascular Agents; Disease; Hexamethonium; Humans; Hypertension; Muscle Relaxants, Central; Patients

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Hydralazine; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Cardiovascular Agents; Ergot Alkaloids; Essential Hypertension; Hypertension; Oxytocics

Topics: Cardiovascular Agents; Exercise Test; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central; Povidone

Topics: Cardiovascular Agents; Communication; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Hydralazine; Hypertension; Muscle Relaxants, Central; Salts; Sympatholytics

Topics: Cardiovascular Agents; Hexamethonium; Humans; Hypertension; Muscle Relaxants, Central; Rauwolfia; Secologanin Tryptamine Alkaloids

Topics: Blood Pressure; Blood Pressure Determination; Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Shock; Sympatholytics

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central; Salts

Topics: Cardiovascular Agents; Hexamethonium; Humans; Hydralazine; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Ambulatory Care; Cardiovascular Agents; Hexamethonium; Humans; Hydralazine; Hypertension; Muscle Relaxants, Central; Outpatients; Sympatholytics

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Prognosis; Sympathectomy

Topics: Cardiovascular Agents; Hexamethonium; Hydralazine; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Humans; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central; Salts

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Autonomic Agents; Cardiovascular Agents; Hypertension; Muscle Relaxants, Central

Topics: Antihypertensive Agents; Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Sympatholytics; Veratrum Alkaloids

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Alkaloids; Cardiovascular Agents; Ergolines; Ergot Alkaloids; Humans; Hypertension

Topics: Cardiovascular Agents; Ergot Alkaloids; Hypertension; Oxytocics

Topics: Cardiovascular Agents; Death; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Hypertension

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Anesthesia; Cardiovascular Agents; Gastrointestinal Diseases; Hexamethonium; Humans; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Disease Management; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Disease Management; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Ergot Alkaloids; Hypertension; Oxytocics; Tablets

Topics: Cardiovascular Agents; Hexamethonium; Hydralazine; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Adrenergic Antagonists; Cardiovascular Agents; Ergot Alkaloids; Hypertension; Oxytocics

Topics: Angina Pectoris; Cardiovascular Agents; Cyclandelate; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Cardiovascular Agents; Ergot Alkaloids; Hypertension; Oxytocics

Topics: Cardiovascular Agents; Essential Hypertension; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Hydralazine; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Bis-Trimethylammonium Compounds; Cardiovascular Agents; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Essential Hypertension; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Child; Diagnosis, Differential; Humans; Hypertension; Infant; Muscle Relaxants, Central; Paraganglioma; Pheochromocytoma

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Hexamethonium; Hydralazine; Hypertension; Muscle Relaxants, Central; Oxytocics; Sympatholytics

Topics: Bis-Trimethylammonium Compounds; Cardiovascular Agents; Hypertension; Muscle Relaxants, Central

Topics: Blood Pressure; Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Hypertension

Topics: Alkaloids; Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Hypertension; Oxytocics

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Salts

Topics: Bis-Trimethylammonium Compounds; Cardiovascular Agents; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Ergot Alkaloids; Essential Hypertension; Hypertension

Topics: Cardiovascular Agents; Hexamethonium; Hydralazine; Hypertension; Muscle Relaxants, Central

Topics: Blood Pressure; Blood Pressure Determination; Cardiovascular Agents; Hexamethonium; Humans; Hypertension; Muscle Relaxants, Central; Veratrum Alkaloids

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Sympatholytics

Topics: Cardiovascular Agents; Hexamethonium Compounds; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Hydralazine; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central; Veratrum Alkaloids

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central; Salts

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central; Salts

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Dihydroergotoxine; Ergot Alkaloids; Hypertension; Oxytocics

Topics: Cardiovascular Agents; Ergot Alkaloids; Hypertension; Oxytocics

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Blood Pressure; Cardiovascular Agents; Humans; Hypertension; Hypotension; Injections; Muscle Relaxants, Central; Syringes

Topics: Cardiovascular Agents; Hexamethonium Compounds; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Bis-Trimethylammonium Compounds; Cardiovascular Agents; Hypertension; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Ergot Alkaloids; Essential Hypertension; Humans; Hypertension; Research; Secale

Topics: Cardiovascular Agents; Ergot Alkaloids; Hypertension; Oxytocics

Topics: Cardiovascular Agents; Hexamethonium; Hypertension; Muscle Relaxants, Central

Topics: Blood Pressure; Blood Pressure Determination; Cardiovascular Agents; Ergot Alkaloids; Hypertension

Topics: Blood Pressure; Blood Pressure Determination; Cardiovascular Agents; Ergot Alkaloids; Hypertension

Topics: Basal Metabolism; Blood Pressure; Blood Pressure Determination; Cardiovascular Agents; Ergonovine; Ergot Alkaloids; Hypertension; Metabolism